Adherence to antihypertensive or antihyperlipidemic co-medications in diabetes: patterns,
predictors, and intervention
Alfian, Sofa
DOI:
10.33612/diss.135922731
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Publication date: 2020
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Alfian, S. (2020). Adherence to antihypertensive or antihyperlipidemic co-medications in diabetes: patterns, predictors, and intervention. University of Groningen. https://doi.org/10.33612/diss.135922731
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APPENDICES
SUMMARY
NEDERLANDSE SAMENVATTING
ACKNOWLEDGEMENTS
ABOUT THE AUTHOR
PHD PORTOFOLIO
SUMMARY
Adherence and persistence to chronic preventive medications remain poor in high- and low-middle-income countries, despite the development of many interventions to address this behaviour. In patients with type 2 diabetes, medication taking is particularly complex since they often need not only antidiabetic medication, but also antihypertensive and antihyperlipidemic co-medications. While much research has been conducted to assess adherence and persistence to antidiabetic medication and its underlying factors, there is limited knowledge regarding their adherence and persistence with cardiovascular co-medications among these patients. This thesis aims to get more insight in the patterns and predictors of adherence and non-persistence to antihypertensive and antihyperlipidemic medications among patients with type 2 diabetes. Further, these insights were used to develop a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive medications among patients with type 2 diabetes in Indonesia. To achieve these aims, the studies were conducted in the Netherlands (Part I) and in Indonesia (Part II).
In Part I, we described non-adherence and non-persistence to cardiometabolic
medications in patients with type 2 diabetes using pharmacy databases in the Netherlands. In Chapter 2, we reviewed the measures that have been proposed or
used to estimate medication adherence and persistence to multiple cardiometabolic medications. Five distinct adherence measures were identified, including adherence to “all” (at least 80% adherence to each medication) , to “any” (at least 80% adherence to any –at least one– medication, usually from the same therapeutic level), to “both” medications (calculating adherence based on the number of days when both medications were available), “average adherence” (calculating adherence for each individual medication and presenting the overall average), and “highest/lowest adherence” (calculating adherence for each medication and presenting the highest and lowest number as measure of adherence). Three distinct persistence measures were identified, including persistence with “all” (persistent when each medication is without a gap), with “both” (persistent when no gaps in two medications concurrently), and with “any” medication (persistent when no gap in at least one medication, usually from the same therapeutic level).
In Chapter 3 and Chapter 4, we focused on the patterns and non-modifiable
pharmacy-based predictors of non-adherence, non-persistence, and/or re-initiation to antihypertensive medications and statins in Dutch patients with type 2 diabetes. In
Chapter 3, we observed that the first year after initiation is the most crucial with regard
to non-adherence and non-persistence with antihypertensive, and the predictors are clearly different for both processes. In Chapter 4, we looked at statins and observed
that non-persistence was the foremost problem in the first year after statin initiation, while non-adherence became more of an issue in the second and third year. Predictors of statin non-persistence were different from predictors of non-adherence.
In Part II, we developed and tested a targeted and tailored pharmacist-led intervention
to improve adherence to antihypertensive medications among patients with type 2 diabetes in Indonesia. In Chapter 5, around half of 571 diabetes patients who were
prescribed antihypertensive and/or antihyperlipidemic medications were non-adherent to this medication. We observed that medication beliefs were a potentially modifiable factor associated with non-adherence to antihypertensive as well as to antihyperlipidemic medications. We described the study protocol for evaluating a targeted and tailored pharmacist-led intervention in a cluster randomised trial in
Chapter 6. In Chapter 7, we observed that this low-cost, targeted and tailored
pharmacist-led intervention significantly improved medication adherence. There was a non-significant positive difference in medication necessity-concerns beliefs between the intervention and control group. The effectiveness of intervention can be explained by its good implementation in the trial setting, and the appreciation of the tailored intervention by both the pharmacists and the patients (Chapter 8).
It can be concluded that both non-modifiable and modifiable factors are relevant for interventions to improve non-adherence and/or non-persistence to cardiometabolic medications. Non-modifiable factors, including the drug classes involved and the time since medication initiation, are important for targeting interventions. Modifiable factors, including lack of knowledge, motivation and forgetfulness, can be addressed in a tailored intervention. While the extent of pharmacist involvement in patient care may vary between the Netherlands and Indonesia, a targeted and tailored pharmacist-led intervention that is effective and can be integrated into the community pharmacy workflow is needed in both countries.
A
SummaryNEDERLANDSE SAMENVATTING
Therapietrouw -zowel adherentie als persistentie- van preventieve geneesmiddelen die chronisch moeten worden gebruikt, is suboptimaal in zowel hoog- als middeninkomenslanden. Dit blijkt nog altijd het geval ondanks de ontwikkeling van verschillende soorten strategieën om therapietrouw te ondersteunen. Met name bij patiënten met type 2 diabetes kan het goed gebruik van medicatie complex zijn, omdat zij naast antidiabetica vaak ook antihypertensiva en antihyperlipidemica nodig hebben. Ondanks het vele onderzoek naar adherentie en persistentie van antidiabetica en de onderliggende factoren, is er weinig bekend over de therapietrouw van cardiovasculaire medicatie bij deze patiënten. Dit proefschrift heeft als doel om meer inzicht te krijgen in de patronen en voorspellende factoren van therapietrouw bij het gebruik van antihypertensiva en antihyperlipidemica bij patiënten met type 2 diabetes. Vervolgens zijn deze inzichten gebruikt om een doelgerichte en op maat gemaakte apotheker-geleide voorlichtingsstrategie te ontwikkelen, om de therapietrouw van antihypertensiva te verbeteren bij patiënten met type 2 diabetes in Indonesië. Het onderzoek gepresenteerd in dit proefschrift is deels uitgevoerd in Nederland (Deel I) en deels in Indonesië (Deel II).
In Deel I wordt het gebrek aan therapietrouw (non-adherentie en non-persistentie)
beschreven voor cardiometabole geneesmiddelen bij patiënten met diabetes type 2 met behulp van farmacie-databases. In Hoofdstuk 2 onderzoeken we de methoden
die zijn toegepast om adherentie en persistentie te meten bij gelijktijdig gebruik van meerdere cardiometabole medicijnen. Vijf specifieke maten van therapietrouw zijn onderscheiden, waaronder adherentie voor ‘alle’ medicatie (ten minste 80% gebruik van elk medicijn), voor ‘enige’ medicatie (ten minste 80% gebruik van minstens één medicijn, doorgaans van hetzelfde therapeutische niveau), de ‘gemiddelde adherentie’ (adherentie wordt berekend voor elk individueel medicijn en toont het gemiddelde), en ‘hoogste/laagste adherentie’ (adherence wordt berekend voor elk medicijn en toont de hoogste en laagste waarde als maat voor therapietrouw). Voor persistentie zijn drie specifieke maten gevonden, waaronder persistentie voor ‘alle’ medicatie (wanneer elk medicijn is door gebruikt zonder lange tussenpozen), en met ‘enige’ medicatie (wanneer ten minste één medicijn is door gebruikt, doorgaans van hetzelfde therapeutisch niveau).
In Hoofdstuk 3 en Hoofdstuk 4 focussen we op de patronen en farmacie-gebaseerde
voorspellers van non-adherentie, non-persistentie, en/of herinitiatie van antihypertensiva en statines bij Nederlandse patiënten met diabetes type 2. In
Hoofdstuk 3 zien we dat het eerste jaar na initiatie het meest cruciaal is als het gaat
om non-adherentie en non-persistentie van antihypertensiva, en dat de predictoren duidelijk verschillen voor beide processen. In Hoofdstuk 4 onderzoeken we
therapietrouw van statines en zien we dat non-persistentie het meest voorkomende probleem was in het eerste jaar na start van de statine, terwijl non-adherentie een
groter probleem werd in het tweede en derde jaar. Ook voor statines zijn de predictoren van non-persistentie en non-adherentie niet gelijk.
In Deel II ontwikkelen en testen we een doelgerichte en op maat gemaakte
voorlichtingsstrategie geleid door een apotheker om de therapietrouw voor antihypertensiva te verbeteren onder patiënten met type 2 diabetes in Indonesië. In
Hoofdstuk 5 zien we dat rond de helft van de 571 diabetespatiënten die
antihypertensiva en/of antihyperlipidemica voorgeschreven kregen, non-adherent waren voor deze medicatie. We zagen dat opvattingen over het geneesmiddel mogelijk een aanpasbare factor was, geassocieerd met non-adherentie voor antihypertensiva en ook antihyperlipidemica. We beschrijven daarna een onderzoeksprotocol voor het evalueren van een doelgerichte en op maat gemaakte voorlichtingsstrategie door de apotheker, in een clustergerandomiseerd onderzoek in
Hoofdstuk 6. In Hoofdstuk 7 tonen we dat deze strategie een significante verbetering
teweeg brengt in de therapietrouw bij mensen met type 2 diabetes. Er leek enig positief verschil in de balans tussen opvattingen over de noodzakelijkheid en mogelijke problemen met medicatie tussen de interventie- en de controlegroep, maar dit was niet statistisch significant. De effectiviteit van voorlichtingsstrategie kan worden verklaard door de goede implementatie ervan in de onderzoekssetting, en de waardering van de aanpak door zowel de apothekers als de patiënten (Hoofdstuk 8).
Er kan worden geconcludeerd dat zowel niet-aanpasbare als aanpasbare factoren relevant zijn voor therapietrouw en strategieën om adherentie en/of non-persistentie van cardiometabole geneesmiddelen te verbeteren. Niet-aanpasbare factoren, zoals de klassen van geneesmiddelen en de tijd sinds het begin van de behandeling, zijn belangrijk bij het selecteren van mensen voor gerichte voorlichting. Aanpasbare factoren, waaronder gebrekkige kennis, motivatie en vergeetachtigheid, kunnen aangepakt worden door op maat gemaaktevoorlichting. De rol van de apotheker in de farmaceutische patiëntenzorg kan verschillen tussen Nederland en Indonesië, maar een voorlichtingsstrategie die de therapietrouw verbetert en geïntegreerd kan worden in de werkwijze van de openbare apotheek, is nodig in beide landen. De ontwikkelde doelgerichte en op maatgemaakte aanpak is relatief simpel en kan een bruikbare stap daarbij zijn.
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Nederlandse samenvattingACKNOWLEDGEMENT
First and foremost, I would like to convey my greatest gratitude to Allah, the Almighty, for giving me strength to finish my PhD study.
This thesis would not be finished without the enormous support from many remarkable people. Therefore, I would like to express my sincere gratitude to those who have contributed and supported me during this amazing journey.
I would like to sincerely and specially thank my promotors, Prof. Eelko Hak and Prof. Petra Denig.
Dear Eelko, thank you for giving me a chance to work under your supervision. I truly
appreciate your continuous support and guidance over the years. You gave me the independence needed to develop my research and provided valuable inputs for the entire project. Your fast response and problem-solving abilities were of great help whenever I faced difficulties. Thank you for your thoughtfulness and your words of encouragement, which made my PhD journey a delightful experience. You also inspired me to achieve a healthy work-life balance and constantly reminded me to spend time with my family. Thank you for not only being a supportive promotor but also a great teacher.
Dear Petra, I truly appreciate your support and patience to guide me over the years.
Your meticulous review and critical thinking inspired me to always think one or two steps ahead. I continue to be amazed by your dedication to the quality and integrity of our research projects. You did a wonderful job of teaching me what I needed to know to become a good and independent researcher. I have learnt so much from you. You also motivated me to become more confident and believe in myself. Thank you for helping me grow and supporting me to be the best I can be.
My sincere thanks also go to Rizky Abdulah, PhD (Universitas Padjadjaran,
Indonesia), who extended valuable help when I conducted PhD projects in Indonesia. Dear sensei, your countless support made it possible for me to pursue my PhD study abroad. I still remember the first time you taught me how to write and submit a research manuscript. I am so much farther now than I would have been if I had not had your guidance. I can never thank you enough for your support and encouragement. I would also like to extend my gratitude to all my co-authors who supported me to finish all my PhD projects. Thank you to Pawida Worawutputtapong, Dr. C.C.M. (Nynke) Schuiling-Veninga, Dr. Jurjen van der Schans, Jens H. J. Bos, Dr. Ivan S. Pradipta, Dr. Andre Coelho, Prof. Dyah A. Perwitasari, Nurul Annisa, Dr. Fajriansyah, and Dr. Job F.M van Boven. Dear Pawida, thank you for all your
suggestions and inputs during IADB protocol writing. Dear Jurjen, I really appreciate
all your help, especially during my first year of PhD. Thank you for your kindness. Dear
Jens, thank you for your help with the IADB database. I remember being amazed by
your simple SQL-code compared with mine. Dear Ivan, thank you for being so
generous with your time to help me with the systematic review. Dear Andre, thank you
for your valuable suggestions about my antihypertensive project. Dear Prof. Dyah,
teh Nisa, mas Fajrin, thank you for your contribution during the multicentre study.
Dear Job, your passion for research is remarkable and admirable. Thank you for your
support during the development of the “adherence wheel”. I will miss our lively discussions.
I would like to thank the assessment committee: Prof. J.W.J. Beulens, Prof. G.J. Navis, and Prof. C.E.M.J. van Dijk for taking the time to read and assess my thesis. I also thank all current and former members of Unit PTEE: Prof. B. Wilfert, Prof. K. Taxis, Prof. M. J. Postma, Dr. Nynke, Dr. Pepijn, Abrham, mas Akbar, Bert (thank
you for teaching me some words in Dutch), teh Doti, Ellen, Eva, mas Fajri, Felicia
(thank you for translating my English summary to Dutch), Heleen, Hugo (thank you
for solving all the problems related to my computer), mba Ira (thank you for being a
good listener, mba), Jens, Jurjen, Joy, mas Khairul, Linda, Li, mba Lusi, Monique Schurmaan, Pepjin, Pieter, Qi, mas Riswandy, Stijn (thank you for helping me with
multiple imputations), mba Sylvi, Taichi, Tanja, Thea, Talitha, mba Tia, mas Ury, Yuanyuan. Thank you for all our discussions during our group meetings, our random
conversations during lunch, and for bringing many beautiful memories during my PhD journey. Special thanks to my officemates: teh Neily, mas Didik, Christiaan, and Simon. I love that we had such engaging conversations about a myriad of topics. All
of you have helped me adapt to the Dutch culture. Thank you for being helpful and wonderful officemates. I would also like to express my special gratitude to Jannie, Yvonne, and Anja who always helped me with all my administrative problems.
My special thanks also go to teh Monik and mba Afifah for being my paranymphs. I
will miss our lunches and “curhat” sessions which lasted so many hours. Thank you for always being there for me.
My deep gratitude also goes to the members of Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran: Prof. Anas Subarnas, Prof. Ajeng Diantini, Prof. Keri Lestari, Prof. Jutti Levita, Prof. Sri adi Sumiwi, Prof. Ahmad Muhtadi, Dr. Eli Halimah. My special thanks also go to teh Maya, teh Dika, pak Dipta, pak Auliya, pak Angga, bu Molly, bu Ellin, teh Eli, teh Rizki, Rano, Arif, Pak Adi Priyanto, thank you for your kindness. Many thanks to the
member of the “Avengers”: Putri, teh Noris, teh Rina, Rima, Ega, Imam, kang Patih,
Rano, and bu Yuni, together, we are stronger!
A
My special thanks also go to my current and former Kajuit 94 family: kang Rully-Intan, Zaki-Nadia, mas Oce-mba Diani, Alif, and Haikal for the unforgettable moments we
have shared. Thank you for bringing so much joy and happiness to our home. I would like to give my special gratitude to “Rumah Tahfidz Kajuit”: Mualim Ahmed, Salim-mba Atika, mba Roos, Bu Elvira, kang Hegar-teh Icha, mas Chalis-mba Jean, mas Ristiono-mba Afifah, pak Yopi-mba Dewi, mba Inda-mas Feri, kang Fajar-teh Monik, mas Budi-mba Nonny, mas Firas, Ghozi, Jabar-Fathiya. I never
expected that I would meet such an amazing and lovely community here. Our weekly Quran gatherings always remind me to become closer to Allah, the Almighty. I am also indebted to all my current and former friends in Groningen and deGromiest who have been very kind and helpful: budhe Nunung, oom Meno-Uwak Asiyah, oom Herman-budhe Arie, mas Amak-mba Putri, mas Khairul-mba Retno, pak Dipta-teh Dita, mas Ega-mba Irma, mas Lana-mba Arum, Ali-Yosi, mas Joko-mba Uchi, Pak Angga, Pak Deni, mas Surya-Yassarah, mas Didin-mba Anis, mas Azka-mba Aidina, mas Agung-mba Inna, mas Latief-mba Septi, mas Habibie-mba Mawa, mas Romi-mba Arlin, mas Ega-mba Titis, mba Nuril, mba Siti, mba Zamrotul, Pak Tatang, mas Rifqi Rohman, mas Naufal-mba Moza, Pak Asmoro-Bu Rini, mas Fika-mba Nisa, as well as everyone else who could not be listed in this
acknowledgement.
I would like to thank my friends in Sholeha Group and Smart Group: mba Indah,
mba Eha, Salma, Vieke, teh Nada, mba Melinda, Eka, Elvira Lili, Gita. Our lively
discussions always motivate me to learn Islam better.
I would also like to thank my friends in BIOSMART Group: Bu Shinta, Nanas Alien, Zamzam, Deris, Adhitya, and Seno. Thank you for being the best support system
over the years.
I would like to thank the Indonesia Endowment Fund for Education (LPDP) who
financially supported my studies at the University of Groningen, the Netherlands. I cannot wait to return home and dedicate and contribute my knowledge, skills and abilities with full devotion for Indonesia.
Finally, I would like to express my deepest gratitude to my lovely family.
To my beloved brothers, Zamzam Timur Alfian and Zein Gema Alfian, thank you
very much for taking care of our parents during my leave. Dear A Zamzam, I am truly
grateful to have you as my “guardian angel” since I was a little girl. Thank you for always protecting me. Dear Ade Zein, I remember you were crying when I have to
leave to the Netherlands. Thank you for your patience. I will be with you again soon. To my beloved sister-in-law, teh Rantika Sandra, thank you for being a good mother
To my father- and mother-in-law, Rojak D. Sujana and Tini Herlina, as well as my
brothers-in-law, Yanwar Ilham and Arfan Firdaus, thank you very much for all your
unconditional understanding, support, and prayers. I am very grateful to be part of such a supportive family.
To my father and mother, E. Z. Alfian and Ihat Solihat, thank you very much for your
endless love, unconditional understanding and continuous prayers. Dear Mamah and
Apa, no words can describe how blessed and grateful I am to be your daughter. I know
it was not easy to allow your one and only daughter to study abroad. Thank you for making me believe that I can do anything and everything in life. You taught me to be a sholehah daughter and instilled in me the value that Allah, the Almighty, loves me more than you do. All I am now and hope to be is due to your good guidance. Thank you for being wonderful parents. I am forever indebted to the both of you.
To my beloved husband, Yudi Nugraha, I am so lucky to have you by my side. Dear Aa, thank you for your patience, encouragement and endless love. There is not a
single day when I do not thank Allah, the Almighty, for giving me such an understanding and caring husband. You watched me succeed, watched me fail, made me laugh and wiped my tears. You were there through all the ups and downs. Thank you for always believing in me and supporting me. Let’s do our best to be sholeh and sholehah. I want to hold your hand in Jannah and say, ‘we are finally here’, Insya Allah.
Groningen, July 2020 Sofa Dewi Alfian
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AcknowledgementABOUT THE AUTHOR
Sofa Dewi Alfian (1988) was born in Tasikmalaya, Indonesia. She completed her bachelor’s degree (2011) and pharmacist’s degree (2012) from the Faculty of Pharmacy, Universitas Padjadjaran. After graduating, she worked as a junior lecturer and researcher at the Department of Pharmacology and Pharmacy Clinic, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia. At the same time, she also worked as a managing editor in the Indonesian Journal of Clinical Pharmacy.
Funded by the Ministry of Research, Technology and Higher Education of the Republic of Indonesia under the scheme of ‘Beasiswa Unggulan’ scholarship, she continued her study in the Faculty of Medicine, Universitas Padjadjaran, Indonesia, and obtained a master’s degree in public health (2014). Funded by the Indonesia Endowment Fund for Education (LPDP), she started a PhD trajectory in September 2016 under the supervision of Prof. Eelko Hak and Prof. Petra Denig at the Unit of Pharmaco-Therapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, the Netherlands. Her research focused on improving adherence to antihypertensive and antihyperlipidemic medications among patients with diabetes. During her PhD, she actively presented her work in international conferences and published her studies in the top scientific journal. At the end of her PhD study, she received a grant from the Southeast Asia-Europe Joint Funding Scheme for Research and Innovation to continue her research in developing a smart-phone application to improve medication adherence in Indonesia. After finishing her PhD, she will continue her career as a lecturer and researcher at the Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia.
PHD PORTOFOLIO
Name : Sofa Dewi Alfian
Unit of PhD : Unit of Pharmaco-Therapy, -Epidemiology and –Economics, Department of Pharmacy, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, the Netherlands. PhD period : 2016-2020
Promotors : Prof. Dr. Eelko Hak Prof. Dr. Petra Denig PUBLICATIONS DURING PHD STUDY
Alfian SD, Worawutputtapong P, Schuiling-Veninga CCM, van der Schans J, Bos JHJ, Hak E, Denig P. Pharmacy-based predictors of persistence with and non-adherence to statin treatment among patients on oral diabetes medication in the Netherlands. Current medical research and opinion. 2018 Jun 3;34(6):1013-9. Alfian SD, Pradipta IS, Hak E, Denig P. A systematic review finds inconsistency in the measures used to estimate adherence and persistence to multiple cardiometabolic medications. Journal of Clinical Epidemiology. 2019 Apr 1;108:44e53.
Alfian SD, Denig P, Coelho A, Hak E. Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands. PLoS ONE. 2019 Nov 15: 14(11): e0225390
Alfian SD, Annisa N, Fajriansyah F, Perwitasari DA, Abdulah R, Hak E, Denig P.
Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia. Journal of General Internal Medicine. 2020 Apr 16.
Alfian SD, Abdulah R, Denig P, van Boven JF, Hak E. Protocol: Targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: study protocol of a cluster randomised controlled trial. BMJ Open. 2020;10(1).
Alfian SD, van Boven JF, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: a cluster randomized controlled trial. (under review in British Journal of Clinical Pharmacology) Alfian SD, van Boven JF, Abdulah R, Hak E, Denig P Process evaluation of implementing a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in
Indonesian Community Health Centres. (In preparation for submision)
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PhD portofolioAlfian SD, Sukandar H, Lestari K, Abdulah R. Medication adherence contributes to
an improved quality of life in type 2 diabetes mellitus patients: A cross-sectional study.
Diabetes Therapy. 2016 Dec 1;7(4):755-64.
Alfian SD, Sinuraya RK, Kautsar AP, Abdulah R. Consumer expectation on service
quality provide by pharmacist in self-medication practices and its associated factors in Bandung, Indonesia. Southeast Asian J Trop Med Public Health. 2016 Nov 1;47(6):1379-84.
Barliana MI, Amalya SN, Pradipta IS, Alfian SD, Kusuma AS, Milanda T, Abdulah R. DNA methyltransferase 3A gene polymorphism contributes to daily life stress susceptibility. Psychol Res Behav Manag. 2017 Dec 15;10:395-401.
Barliana MI, Yolanda PD, Rostinawati T, Ng H, Alfian SD, Abdulah R, Diantini A.
Polymorphism of the APM1 gene in subjects with central obesity related to lower high-density lipoprotein cholesterol. Diabetes, Metabolic Syndrome and Obesity: Targets
and Therapy. 2019;12:2317.
Insani WN, Qonita NA, Jannah SS, Nuraliyah NM, Supadmi W, Gatera VA, Alfian SD,
Abdulah R. Improper disposal practice of unused and expired pharmaceutical products in Indonesian households. Heliyon. 2020 Jul 1;6(7):e04551.
Oktora MP, Alfian SD, BosJHJ, Schuiling-VeningaCCM, TaxisK, HakE, Denig P. Trends in polypharmacy and potentially inappropriate medication (PIM) among older and middle-aged people treated for diabetes. (Submitted to British Journal of Clinical Pharmacology)
CONFERENCES
Alfian SD, Worawutputtapong P, Schuiling-Veninga CC, van der Schans J, Bos JH, Hak E, Denig P. Predictors of non-persistence and non-adherence with statin therapy among patients on oral diabetes medication in the Netherlands. The 33rd International Conference on Pharmacoepidemiology & Therapeutic Risk Management. Montreal, Canada. August 26-30, 2017. (Poster presentation)
Alfian SD, Worawutputtapong P, Schuiling-Veninga CC, van der Schans J, Bos JH, Hak E, Denig P. Pharmacy-based predictors of non-persistence and non-adherence to statin treatment among patients on oral diabetes medication in the Netherlands. Annual Dutch Diabetes Research Meeting 2017. Oosterbeek, the Netherlands. November 30-December 1, 2017. (Oral presentation)
Alfian SD, Pradipta IS, Hak E, Denig P. A systematic review of measures for calculating adherence and persistence to multiple medication from prescription data. The 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. Prague, Czech Republic. August 22-26, 2018. (Poster presentation) Alfian SD, Pradipta IS, Hak E, Denig P. A systematic review of measures to estimate adherence and persistence to multiple medications. The 22nd European Society for
Patient Adherence, Compliance, and Persistence (ESPACOMP). Dublin, Ireland. November 29-December 1, 2018. (Oral presentation)
Alfian SD, Denig P, Coelho A, Hak E. Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands. The 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. Philadelphia, USA. August 24-28, 2019. (Oral presentation)
Alfian SD, Annisa N, Fajriansyah F, Perwitasari DA, Abdulah R, Hak E, Denig P.
Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia. EuroDURG Conference. Szeged, Hungary. March 4-7, 2020.
(Oral presentation)
Alfian SD, van Boven JF, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: a cluster randomized controlled trial. The 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. September 16-17, 2020. (Spotlight poster presentation)
Alfian SD, van Boven JF, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: a cluster randomized controlled trial. The 24th European Society for Patient Adherence, Compliance, and Persistence (ESPACOMP). (Submitted)
