Medication Adherence Pattern for Benign Prostatic Hyperplasia: A Cross-Sectional Study (original) (raw)
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Evaluating Use Patterns of and Adherence to Medications for Benign Prostatic Hyperplasia
The Journal of Urology, 2009
We investigated adherence to benign prostatic hyperplasia medications in a California Medicaid population. Using California Medicaid data on 1995 to 2004 we identified adult males 40 years old or older with 1 or more diagnosis and 2 or more prescription fills for benign prostatic hyperplasia. Patients with 2 fills on the same day were assigned to the multiple medication cohort. Adherence was measured using the medication possession ratio for the index medication and the proportion of days covered for any benign prostatic hyperplasia medication. Patients with a medication possession ratio or proportion of days covered of 0.8 or greater were considered adherent. A Cox proportional hazards model was used to assess the relative hazards associated with discontinuation. Multiple logistic regression was used to investigate factors associated with nonadherence or a benign prostatic hyperplasia related procedure. Of the total population of 2,640 men 40% were adherent with any benign prostatic hyperplasia medication. A significantly greater proportion of patients using multiple medications and finasteride were adherent with any benign prostatic hyperplasia medication (62% and 55%, respectively, p <0.0001). Doxazosin, terazosin and tamsulosin use was associated with nonadherence (p = 0.008, 0.04 and 0.03, respectively). Younger patients and those changing medications were more likely to discontinue (p = 0.01 and <0.0001), while patients using multiple medications and those experiencing a gap were at lower risk for discontinuation (p = 0.01 and <0.0001, respectively). Predictors of a procedure included an index prescription in 1999 or later, a urologist visit and nonadherence to any benign prostatic hyperplasia medication (p = 0.01, <0.0001 and <0.0001, respectively). Adherence to alpha-blockers was less than adherence to finasteride or multiple medications and nonadherence was significantly associated with a procedure. Interventions focused on improving adherence to benign prostatic hyperplasia medications are clearly needed.
European urology, 2014
Little is known about drug adherence in men treated for lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH) is one of the causes of LUTS. To examine adherence to pharmacological therapy and its clinical value in men with LUTS. Population-based cohort study using an administrative prescription database and hospital discharge codes for 1.5 million men aged ≥40 yr treated with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) alone or in combination (CT). Therapy with ABs and/or 5ARIs. The 1-yr and long-term adherence; hospitalization rates for BPH and BPH surgery. Multivariate Cox proportional hazards regression model, propensity score matching, and sensitivity analyses. The 1-yr adherence was 29% in patients exposed to at least 6-mo therapy. Patients on CT had a higher discontinuation rate in the first 2 yr compared to those on monotherapy (p<0.0001). Overall hospitalization rates for BPH and BPH surgery were 9.04 and 12.6 per 1000 patient-years, re...
BMC urology, 2015
Recent studies showed that the non-adherence to the pharmacological therapy of patients affected by BPH-associated LUTS increased the risk of clinical progression of BPH. We examined the patients adherence to pharmacological therapy and its clinical consequences in men with BPH-associated LUTS looking at the differences between drug classes comparing mono vs combination therapy. A retrospective, population-based cohort study, using prescription administrative database and hospital discharge codes from a total of 1.5 million Italian men. Patients ≥40 years, administered alpha-blockers (AB) and 5alpha-reductase inhibitors (5ARIs), alone or in combination (CT), for BPH-associated LUTS were analyzed. The 1-year and long term adherence together with the analyses of hospitalization rates for BPH and BPH-related surgery were examined using multivariable Cox proportional hazards regression model and Pearson chi square test. Patients exposed to at least 6 months of therapy had a 1-year overa...
The aging male : the official journal of the International Society for the Study of the Aging Male, 2013
Objectives: To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. Methods: A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient's medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis. Results: Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p ¼ 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p ¼ 0.05) to have complaints with their medications compared to patients who self-managed. Conclusions: Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.
YMER Digital
Background The present study aimed to evaluate the prescribing pattern and to assess the therapeutic outcome in the management of Benign Prostatic hyperplasia using IPSS and to provide a best treatment option for management of BPH. Methodology It is prospective observational study, 80 patients ≥50 years with BPH and treated with alpha- 1 blockers and 5-alpha reductase inhibitors were included in our study. The materials we used in our study include Informed consent form, Patient data collection form, and International Prostate Symptom Score. Results In IPSS follow up, we got mean baseline IPSS as 13.18 out of 35 and the mean follow up IPSS as 5.18. It shows that there is significant reduction of symptoms. We got mean difference of monotherapy and combination therapy as 7 and 8. Results with p<0.05 were considered as significant. Conclusion The therapeutic outcomes in evaluating treatment benefits in patients with LUTS/BPH were improvement in subjective symptoms and quality of lif...
International Journal of Clinical Pharmacy, 2019
Background Lower urinary tract symptoms due to benign prostatic hyperplasia set restriction to patients' daily life activities and decrease their quality of life. Adherence to medications is considered a core element to improve patients' clinical outcomes. Objective To evaluate the role of clinical pharmacist in improving adherence to medication, reducing severity of symptoms, and improving quality of life in this group of patients. Setting The study was conducted in urology outpatients' clinics in Amman, Jordan. Methods This was a prospective randomized controlled trial, patients were randomly allocated into intervention group or control group. Patients in the intervention group were offered a pharmaceutical care service and patients in the control group received regular healthcare provided by urologist and then followed for 1 month. Main outcome measures Morisky Medication Adherence Score and International Prostate Symptom Score. Results Among 209 patients completed the study, 105 were in the intervention group and 104 in the control group. By the end of the study, 91.4% of the intervention group patients became adherent to their medication compared to 72.1% in the control group (p < 0.0001). At follow up, the severity of the symptoms to calculated score was lower in the intervention group (mean 15.6 ± 5.69) compared to control group (mean 13.9 ± 5.43) (p < 0.0001). The quality of life score were better in the intervention group compared to the control group at follow-up (p < 0.0001). Conclusion The current findings indicate that implementing clinical pharmacy services can positively increase the level of adherence to medications. This was accompanied by modest improvement in the severity of urinary symptoms in benign prostatic hyperplasia and in quality of life for patients. Hence, clinical pharmacy services could provide beneficence in outpatient setting.
International Urology and Nephrology, 2013
Purpose The purpose of the study is to estimate the trends in drug prescriptions and the hospitalization rates for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) in real-life clinical practice, using information deriving from administrative databases of the Italian health care system. Methods Prescription data on approximately 1,500,000 men over 40 were examined, and prescribed boxes of alpha-blockers (ABs) and/or 5 alpha reductase inhibitors (5ARI) were calculated for 5 consecutive years, from 2004 to 2008. Annual use prevalence and incidence rates for each drug class and for the combination therapy (CT) were calculated according to age for the entire study period. Hospitalization rates for reasons related to LUTS/BPH were also evaluated for the same time period. Results The overall distribution of drugs for LUTS/BPH, in terms of number of boxes prescribed, increased by 43 %. This increase was accounted for by both classes of drugs although it was greater for 5ARI than for AB (?49 vs ?41 %). The prevalence of CT showed a substantial increase to almost 25 % in patients aged C75. Hospitalization rate for BPH/LUTS-related reasons decreased during the study period (8 and 3 % per year for non-surgical and surgical reasons, respectively). Conclusions The prevalence of the use of drugs prescribed for LUTS/BPH has steadily increased. An increase in terms of prescribed boxes was observed for both classes of drugs, even though the increase was greater for 5ARIs. The reduction in the hospitalization rates needs additional researches. Keywords Benign prostatic hyperplasia Á Alpha-blockers Á 5 alpha reductase inhibitors Á Administrative databases Á Combination therapy
Medical doctors’ attitudes towards prescribing medical treatment for benign prostatic hyperplasia
Scripta Scientifica Salutis Publicae, 2015
INTRODUCTION: Benign prostatic hyperplasia is a disease that mainly affects men aged over 50 years. In Europe, cases of moderate and severe symptoms vary between 14 and 30%. The therapy of BPH includes various methods and is intended to bring about an improvement in symptoms (irritative or obstructive), urodynamic function and quality of life. The objective of this article is to present a survey into the attitudes of a group of urologists, providing care in outpatient and inpatient settings, towards therapeutic approaches in the treatment of benign prostatic hyperplasia (BPH) and the level of familiarity and preference for original Tamsulosin 0.4 mg. MATERIALS AND METHODS: Sociological method: a structured interview with 73 urologists countrywide; Documentary method: research into regulatory documents; Statistical methods: for data processing and analysis of the collected information. RESULTS: In the opinion of the interviewed urologists, original Tamsulosin is the first choice of medication for the management of BPH.
European Urology, 2013
Background: Male lower urinary tract symptoms (LUTS) are one of the most treated diseases, but little is known about patient trajectories in current clinical practice. Objective: To describe the dynamic treatment patterns of LUTS presumably due to benign prostatic obstruction (BPO). Design, settings, and participants: All prescriptions of a 1-adrenergic receptor blocking agents (a 1-blockers), 5a-reductase inhibitors (5-ARIs), and phytotherapy, and all surgeries related to BPO performed in France from 2004 to 2008 were identified using two distinct administrative claim databases maintained by the National Health Insurance system that covers the entire population. After linking the two data sets, all consecutive treatment events were analyzed for each patient. Outcome measurements and statistical analysis: Drug prescription details were assessed for each year, region, and prescriber qualification. Medical treatment initiation, interruption, evolution, and events after surgical management (hospital stay, reoperation, complication rates, and subsequent medical prescriptions) were also investigated. Results and limitations: Overall, 2 620 269 patients were treated within 5 yr, with important geographic variations. Medical treatment was interrupted for approximately 16% of patients. The a 1-blockers were prescribed most frequently, but phytotherapy surprisingly accounted for 27% of all monotherapies and 54% of all combination therapies. General practitioners and urologists (92% and 3.7% of overall prescribers, respectively) exhibited a similar prescription profile. Treatment initiation was medical in 95.4% of cases, consisting primarily of monotherapy using a 1-blockers (60.3%), phytotherapy (31.8%), or 5-ARIs (7.9%). Treatment was modified at extremely high rates within 12 mo of initiation (8.7%, 14.6%, and 12.9%, respectively). The median hospital stay for surgical management was far higher than in clinical trials. Long-term surgical complications and reoperation rates favored open prostatectomy. Incidence of pharmacologic treatment after surgery was as high as 13.8% at 12 mo. Conclusions: This unique dynamic evaluation of clinical practice revealed unexpected results that contrast with previously published evidence from clinical trials. This approach may merit monitored and targeted measures to improve the level of care in the field.