Optimization of Drug Utilization and Medication Adherence

Topic Information

Dear Colleagues,

This Topic focuses on optimizing medicine use and adherence to provide a comprehensive overview of current trends and future directions in drug utilization research. Recognizing that medication-taking behavior is highly complex and individualized, this issue emphasizes the need for multifactorial strategies to enhance medication adherence and evidence of methods to analyze it. Hence, we invite original research articles, reviews, and case studies addressing strategies to improve medication adherence, evaluating the economic impact of non-adherence, and developing innovative approaches to optimize drug utilization. Studies examining strategies to analyze and report medication adherence data as well as the role of healthcare providers, patient education, and technology use in promoting adherence are also welcome. Both quantitative and qualitative (and mixed) methods will be considered. Given that medication adherence is particularly crucial for chronic conditions, we encourage contributions exploring challenges and solutions in chronic disease management and the effectiveness of intervention programs.

Prof. Dr. Enrica Menditto
Dr. Sara Mucherino
Dr. Ignacio Aznar-Lou
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600	Submit
Pharmaceuticals pharmaceuticals	4.3	6.1	2004	13.9 Days	CHF 2900	Submit
Pharmaceutics pharmaceutics	4.9	7.9	2009	15.5 Days	CHF 2900	Submit
Pharmacy pharmacy	2.0	-	2013	24.6 Days	CHF 1800	Submit
Healthcare healthcare	2.4	3.5	2013	20.3 Days	CHF 2700	Submit

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Published Papers (6 papers)

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30 pages, 6346 KiB  

Open AccessArticle

Investigating the Time-Varying Nature of Medication Adherence Predictors: An Experimental Approach Using Andersen’s Behavioral Model of Health Services Use

by Vasco M. Pontinha, Julie A. Patterson, Dave L. Dixon, Norman V. Carroll, D’Arcy Mays, Karen B. Farris and David A. Holdford

Pharmacy 2025, 13(2), 53; https://doi.org/10.3390/pharmacy13020053 - 9 Apr 2025

Viewed by 274

Abstract

Medication adherence is a crucial factor for managing chronic conditions, especially in aging adults. Previous studies have identified predictors of medication adherence. However, current methods fail to capture the time-varying nature of how risk factors can influence adherence behavior. This objective of this [...] Read more.

Medication adherence is a crucial factor for managing chronic conditions, especially in aging adults. Previous studies have identified predictors of medication adherence. However, current methods fail to capture the time-varying nature of how risk factors can influence adherence behavior. This objective of this study was to implement multitrajectory group-based models to compare a time-varying to a time-fixed approach to identifying non-adherence risk factors. The study population comprised 11,068 Medicare beneficiaries aged 65 and older taking select medications for hypertension, high blood cholesterol, and oral diabetes medications, between 2008 and 2016. Time-fixed predictors (e.g., sex, education) were examined using generalized multinomial logistic regression, while time-varying predictors were explored through multitrajectory group-based modeling. Several predisposing, enabling, and need characteristics were identified as risk factors for following at least one non-adherence trajectory. Time-varying predictors displayed an alternative representation of those risk factors, especially depression symptoms. This study highlights the dynamic nature of medication adherence predictors and the utility of multitrajectory modeling. Findings suggest that targeted interventions can be developed by addressing the key time-varying factors affecting adherence. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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18 pages, 745 KiB  

Open AccessSystematic Review

Factors and Disparities Influencing Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-like Peptide 1 Receptor Agonists Initiation in the United States: A Scoping Review of Evidence

by Josiah Moore, Ndidi Iheme, Nicholas S. Rebold, Harriet Kusi, Constance Mere, Uzoamaka Nwaogwugwu, Earl Ettienne, Weerachai Chaijamorn and Dhakrit Rungkitwattanakul

Pharmacy 2025, 13(2), 46; https://doi.org/10.3390/pharmacy13020046 - 19 Mar 2025

Viewed by 441

Abstract

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the [...] Read more.

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the factors and disparities that lead to differences in SGLT2i and GLP-1RA initiation across different ethnic groups. Methods: This scoping review queried databases using key terms related to disparities in the initiation of SGLT2i and GLP-1RA among high-risk populations. Relevant data from eligible studies were extracted, organized, and analyzed thematically to identify key trends and patterns in the literature. Result: Nineteen studies were included in this review. Key risk factors influencing uptake included age, provider type, race, sex, education, comorbidities, insurance, and income, with minority patients consistently showing lower rates of initiation due to systemic barriers and socioeconomic disparities. Patients who were younger, male, had higher education or income levels, and received care from specialists were more likely to use these therapies. Conclusion: The adoption of SGLT2i and GLP-1RA remains suboptimal despite their proven kidney and cardiovascular benefits. Targeted efforts to reduce socioeconomic and racial inequities based on the factors identified should be encouraged. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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9 pages, 584 KiB  

Open AccessCase Report

Ekbom Syndrome Management in Elderly Patients: Challenges in Risperidone Titration and Treatment Adherence

by Florina Madalina Mindru, Adrian Gheorghe Bumbu and Darian Faur

Pharmacy 2025, 13(2), 43; https://doi.org/10.3390/pharmacy13020043 - 16 Mar 2025

Viewed by 338

Abstract

Ekbom Syndrome, also known as Delusional Parasitosis (DP), is considered a rare psychiatric condition. Based on diagnostic criteria, it is characterized by the strong belief of being infested with various parasites, as well as the presence of perceptual disturbances, usually tactile and/or visual [...] Read more.

Ekbom Syndrome, also known as Delusional Parasitosis (DP), is considered a rare psychiatric condition. Based on diagnostic criteria, it is characterized by the strong belief of being infested with various parasites, as well as the presence of perceptual disturbances, usually tactile and/or visual hallucinations. The syndrome can manifest idiopathically or in connection with other medical conditions and substance use. Diagnosis is challenging, as patients tend to pursue dermatological care initially. This case report describes an 81-year-old female diagnosed with Ekbom Syndrome, presenting with severe anxiety, insomnia, and persistent delusions of infestation. Initial treatment with low-dose Risperidone (2 mg/day) was ineffective, requiring a dose escalation to 4 mg/day. However, the patient’s nonadherence to follow-up limited the assessment of long-term outcomes. This case highlights key clinical challenges in elderly patients, particularly dose titration, treatment response, and adherence issues. Comparative analysis with prior case reports suggests that higher doses of Risperidone (3–6 mg/day) may be required for symptom remission, but long-term outcomes remain uncertain. Additionally, nonadherence remains a major barrier, underscoring the need for structured monitoring and caregiver involvement. These findings offer insights into antipsychotic strategies for Ekbom Syndrome, highlighting individualized pharmacotherapy, long-term follow-up, and adherence support in elderly patients. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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11 pages, 522 KiB  

Open AccessArticle

Distinct Regional Pattern of Sedative Psychotropic Drug Use in South Tyrol: A Comparison with National Trends in Italy

by Christian J. Wiedermann, Katia Sangermano, Pasqualina Marino, Dietmar Ausserhofer, Adolf Engl and Giuliano Piccoliori

Pharmacy 2025, 13(2), 32; https://doi.org/10.3390/pharmacy13020032 - 21 Feb 2025

Viewed by 420

Abstract

This study investigated regional variations in the use of sedative psychotropic medications, often prescribed for insomnia, by comparing Italy and the culturally distinct Autonomous Province of Bolzano, South Tyrol. Using daily defined dose (DDD) data per 1000 inhabitants per day, benzodiazepines, Z-drugs, sedative [...] Read more.

This study investigated regional variations in the use of sedative psychotropic medications, often prescribed for insomnia, by comparing Italy and the culturally distinct Autonomous Province of Bolzano, South Tyrol. Using daily defined dose (DDD) data per 1000 inhabitants per day, benzodiazepines, Z-drugs, sedative antidepressants, and melatonin consumption from 2019 to 2023 were examined. The findings indicate a notably lower utilization of benzodiazepines in South Tyrol compared to the national Italian average, alongside a significant increase in sedative antidepressant use, particularly mirtazapine. These disparities likely stem from regional prescribing preferences influenced by cultural, linguistic, and healthcare system factors. While Z-drug consumption remained comparable across regions, melatonin use exhibited a gradual upward trend, albeit less pronounced in South Tyrol. These insights emphasize the necessity for region-specific strategies in optimizing insomnia treatment, balancing pharmacological approaches with non-pharmacological alternatives such as cognitive behavioral therapy for insomnia. Understanding these prescribing trends can inform healthcare policies aimed at reducing long-term sedative use while enhancing patient-centered care in sleep medicine. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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35 pages, 786 KiB  

Open AccessSystematic Review

Medication Non-Adherence in Inflammatory Bowel Disease: A Systematic Review Identifying Risk Factors and Opportunities for Intervention

by Kathryn King, Wladyslawa Czuber-Dochan, Trudie Chalder and Christine Norton

Pharmacy 2025, 13(1), 21; https://doi.org/10.3390/pharmacy13010021 - 7 Feb 2025

Viewed by 1273

Abstract

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and [...] Read more.

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and qualitative studies researching IBD medication adherence between 2011 and 2023 were reviewed. In total, 36,589 participants were included in 79 studies. The associated non-adherence factors were contradictory across studies, with rates notably higher (72–79%) when measured via medication refill. Non-adherence was lower in high-quality studies using self-report measures (10.7–28.7%). The frequent modifiable non-adherence risks were a poor understanding of treatment or disease, medication accessibility and an individual’s organisation and planning. Clinical variables relating to non-adherence were the treatment type, drug regime and disease activity. Depression, negative treatment beliefs/mood and anxiety increased the non-adherence likelihood. The non-modifiable factors of limited finance, younger age and female sex were also risks. Side effects were the main reason cited for IBD non-adherence in interviews. A large, contradictory set of literature exists regarding the factors underpinning IBD non-adherence, influenced by the adherence measures used. Simpler medication regimes and improved accessibility would help to improve adherence. IBD education could enhance patient knowledge and beliefs. Reminders and cues might minimise forgetting medication. Modifying risks through an adherence support intervention could improve outcomes. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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15 pages, 1435 KiB  

Open AccessArticle

Appropriateness of Prescribing Transmucosal Immediate-Release Fentanyl in the Emergency Room, During Hospitalization, and at Discharge: A Retrospective Study

by Gary Punjabi and Elena Ramírez

Pharmaceuticals 2024, 17(12), 1609; https://doi.org/10.3390/ph17121609 - 28 Nov 2024

Viewed by 742

Abstract

Background/Objectives: This study evaluated the appropriateness of transmucosal immediate-release fentanyl (TIRF) prescriptions in a Madrid emergency room during 2019 and 2022, following a 2018 warning about off-label use. Methods: TIRF prescription in the emergency room search yielded 993 patients in 2019 [...] Read more.

Background/Objectives: This study evaluated the appropriateness of transmucosal immediate-release fentanyl (TIRF) prescriptions in a Madrid emergency room during 2019 and 2022, following a 2018 warning about off-label use. Methods: TIRF prescription in the emergency room search yielded 993 patients in 2019 and 1499 in 2022, of which 140 were randomized for the study, 70 in 2019, and 70 in 2022. Dose appropriateness and indication for TIRF were analyzed according to established criteria. Results: Despite a high prevalence of cancer diagnoses (77.9%, 109/140), only 32.9% (46/140) of patients met the appropriateness criteria pre-hospitalization. This improved to 42.5% (51/120) at discharge, but the change was not statistically significant overall. However, focusing on surviving patients reveals a significant improvement in appropriateness, increasing from 30.83% (37/120) to 42.50% (p = 0.002). This improvement was particularly pronounced in 2022 (p = 0.0269), but not in 2019 (p = 0.0771). Interestingly, appropriateness in patients with prior TIRF prescriptions remained relatively stable from pre-hospitalization (46.75%) to discharge (48.78%). A concerningly high proportion of patients with cancer diagnoses (68.75%) received low-dose opioid therapy (<60 MME) at discharge, and 36.8% of patients over 80 years old were co-prescribed benzodiazepines, contradicting prescribing guidelines. Conclusions: This study found inappropriate TIRF prescriptions were common in an emergency room setting, often due to low pre-hospital opioid doses. While hospitalization improved TIRF appropriateness in survivors, especially in 2022, concerning prescribing practices persisted. This emphasizes the need for better education and interventions to ensure safe and effective TIRF use. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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