|Take Your Medicine!|
|Sunday, May 28, 2017|
|9:00 AM–10:50 AM |
|Hyatt Regency, Centennial Ballroom H|
|Area: BPN/CBM; Domain: Translational|
|Chair: Amanda Devoto (Western Michigan University)|
|Discussant: Richard Wayne Fuqua (Western Michigan University)|
|CE Instructor: David P. Jarmolowicz, Ph.D.|
The success for pharmacotherapy depends on the patients taking their prescribed medication. Unfortunately, adherence to prescribed medication averages 50% in developed countries (Sabat, 2003). Reasons for non-adherence can include forgetfulness, lack of information, complex regimens, and poor relationships with clinical staff, among others (Osterberg and Blaschke, 2005). A review of 76 medication adherence studies conducted by Claxton, Cramer, and Pierce (2001) found that as number of required doses increased, adherence decreased. Non-adherence can have serious negative health consequences for the individual, which increases the cost of care. Due to the serious health and economic consequences of adherence to pharmacotherapy regimens, evidence-based interventions to increase medication adherence should be a top priority to behavioral scientists. Presentations will feature a smartphone-based approach to reinforcing antiretroviral adherence in HIV+ adults, employment based reinforcement of adherence to an opioid pharmacotherapy that blocks the effects of drugs like heroin, a delay discounting account of pregnancy- and condom-protected sex among methadone-maintained women, and treatment adherence in Multiple Sclerosis patients. The discussant is an eminent scholar in behavior analysis whose broad range of contributions include work in the areas of traffic and pedestrian safety, education, and developmental disabilities. Taken together, audience members can expect a robust overview of behavior analytic research in the area of medication adherence.
|Instruction Level: Intermediate|
|Keyword(s): contingency management, delay discounting, medication adherence, opiates|
Smartphone-Based Reinforcement of Antiretroviral Adherence in HIV+ Adults
|AMANDA DEVOTO (Western Michigan University), David William Sottile (Western Michigan University), Haily Traxler (Western Michigan University), Anthony DeFulio (Western Michigan University)|
Even though antiretroviral therapy (ART) increases the quality of life for those with HIV and reduces the risk of HIV transmission, only 59% of patients with HIV in North America report adherence >90%. Injection drug use and cocaine use are both related to higher risk for HIV transmission and lower adherence. HIV drug users are thus an important population to target for increasing ART adherence. The purpose of the current project was to test the feasibility and acceptability of a smartphone based ART adherence intervention in drug using HIV patients. Participants were randomized to either a treatment-as-usual control group or the SteadyRx treatment group. Those in the SteadyRx group were given a smartphone with the SteadyRx application. Participants used the smartphone application to record themselves taking their medication for six months. $2.00 was deposited to a reloadable debit card for each day videos were correctly submitted, and bonuses were available for 3 day and 29 day consecutive adherence. MEMS caps were used to monitor adherence in both groups. Results indicate that the system is usable and feasible.
Employment-Based Reinforcement to Promote Naltrexone Adherence and Opiate Abstinence
|BRANTLEY JARVIS (Johns Hopkins University School of Medicine), August F. Holtyn (Johns Hopkins University School of Medicine), Anthony DeFulio (Western Michigan University), Shrinidhi Subramaniam (Johns Hopkins University), Annie Umbricht (Johns Hopkins University School of Medicine), Michael Fingerhood (Johns Hopkins University School of Medicine), George Bigelow (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University)|
Behavioral interventions are needed to improve naltrexone treatment for opioid use disorder. This ongoing study is evaluating employment-based reinforcement for extended-release naltrexone (XR-NTX) adherence and opiate abstinence on decreasing opiate use. After completing an outpatient induction to be eligible for XR-NTX, participants are assigned to a usual care, opiate abstinence, XR-NTX, or opiate abstinence + XR-NTX group. Participants are invited for 24 weeks to the Therapeutic Workplace, a model employment-based program for drug addiction where they can work each weekday. To maintain maximum pay, participants assigned to the opiate abstinence group must provide opiate-negative samples, whereas those assigned to the XR-NTX group must accept naltrexone injections. Both conditions must be met for the opiate abstinence + XR-NTX group. Usual care participants have no contingencies for their pay. Preliminary analyses focusing on the outpatient induction phase show that employment-based reinforcement for opioid abstinence and oral naltrexone adherence was successful getting 58.3% of participants inducted onto naltrexone. Participants coming from longer-term detoxification programs and who were not on parole or probation had more success. Full planned analyses on opiate use during the intervention will provide important information on the separate and combined effects of using incentives for XR-NTX adherence and opiate abstinence.
|On Costs, Benefits, and Treatment Adherence in Multiple Sclerosis|
|DAVID P. JARMOLOWICZ (The University of Kansas), Jared M. Bruce (University of Missouri-Kansas City), Amanda S. Bruce (University of Kansas Medical Center/ Children's Mercy Hospital), Sharon Lynch (University of Kansas Medical Center), Seung- Lark Lim (University of Missouri, Kansas City), Derek D. Reed (The University of Kansas)|
|Abstract: Although current medications for multiple sclerosis (MS) are often highly effective, MS patients often fail to take their medications. Although the reasons for medication noncompliance are surely multifaceted, behavioral economics may provide a lens through which certain aspects of medication compliance can be viewed. MS medications often provide benefits that are both delayed and uncertain. Coupled with the relatively immediate yet often uncertain side effects of these medications, choices to take medications surely entail complex cost (side effects) /benefit (treatment efficacy) weighting that may be highly variable across patients. In the present work, we have examined effects of differing side effect probabilities, and magnitudes on patients’ medication choices and adherence status.|
|Delay Discounting of Pregnancy- and Condom-Protected Sex Among Methadone-Maintained Women|
|DENNIS J. HAND (Thomas Jefferson University), Lindsay Reid (Thomas Jefferson University), Diane Abatemarco (Thomas Jefferson University)|
|Abstract: Over 80% of pregnancies are unintended among women with opioid use disorder (OUD), and use of effective contraceptives is uncommon in this population. When deciding whether to have immediate, unprotected sex or delayed, protected sex, behavior may be more likely directed toward the most immediate alternative even if that alternative carries risk. The present study examined whether delays to protection affect likelihood of engaging in hypothetical pregnancy-protected sex, as well as other measures of self-reported impulsivity. Participants were women aged 18 and older who were receiving medication-assisted treatment for OUD and were not intending to become pregnant in the next 6 months. Participants completed a novel Pregnancy Discounting Task (PDT), the Condom Discounting Task (CDT), Barratt Impulsiveness Scale (BIS), and a Monetary Choice Questionnaire (MCQ). Preference for pregnancy- and condom-protected sex over unprotected sex declined orderly as a function of delay. Furthermore, preference shifted toward immediate, unprotected sex at shorter delays for more desirable partners and for partners deemed less risky for sexually-transmitted infections or pregnancy. These findings replicate prior research on delay discounting of condom-protected sex, and extend the findings to pregnancy-protected sex. Delays to pregnancy protection may partially underlie low contraceptive use among women with OUD.|