FROM THE JOURNAL OF VIRAL HEPATITIS
Patients with chronic hepatitis B who are aged under 35 years or do not see the same clinician consistently are more likely to not take their antiviral medication, finds the largest study of its kind to date.
According to the authors of the research led by Nicole Allard, PhD, from the WHO collaborative Centre for Viral Hepatitis and the Peter Doherty Institute for Infection and Immunity in Melbourne, their findings illustrate the need for clinicians to reinforce the importance of medication adherence at each patient consultation.
Furthermore, “providing more flexible and convenient care arrangements, reminder systems, and working with the individual to maximize medication adherence should be a routine part of clinical practice,” they wrote in their paper published in the Journal of Viral Hepatitis. Previous research had shown that adherence to antiviral therapy in the treatment of hepatitis B was associated with improved patient outcomes. Suboptimal adherence could lead to antiviral resistance or antiviral breakthrough, potentially leading to liver cirrhosis and liver cancer.
Understanding poor adherence in clinical settings, together with the factors associated with lower adherence, was important in informing efforts for promoting adherence, the research team said (J Viral Hepat. 2016. doi: 10.1111/jvh.12582 ).
In their retrospective study they assessed the pharmacy records of 1,026 patients who were dispensed antiviral therapy for hepatitis B across four Australian public hospital outpatient clinics between 2010 and 2013.
They discovered that one in five patients were “nonadherent” to therapy based on a medication possession ratio of less than 0.90 – a cutoff shown in previous studies to be correlated with virologic breakthrough.
One significant factor that affected adherence to medication was being aged under 35 years (P = .002), the research team reported.
This finding was similar to other studies of chronic diseases that had shown younger patients were at a higher risk of nonadherence, the authors noted.
“Recognition of the challenges faced by a younger person regularly taking medication at a time in their lives when they feel well is important,” they wrote.
Poor adherence was also associated with seeing multiple clinicians over shorter periods of time.
“While hospitals accommodate trainees and staffing changes occur regularly, seeking to maximize the consistency of clinical care delivery may be an important strategy to support better adherence and optimizing care for individuals,” they said.
Factors such as variations in the amount of medication, duration of treatment, sex, and cultural background did not affect adherence to medication.
“Adherence is a dynamic process and needs to be addressed regularly in a nonjudgmental way working with individuals towards improved health,” they concluded.