Determinants of Adherence to Diabetes Medications: Findings From a Large Pharmacy Claims Database

Diabetes Care - Tập 38 Số 4 - Trang 604-609 - 2015
M. Sue Kirkman1, Megan T. Rowan-Martin2, Rebecca Levin3, Vivian Fonseca4, Julie A. Schmittdiel5, William H. Herman6, Ronald E. Aubert7
11University of North Carolina School of Medicine, Chapel Hill, NC
2American Diabetes Association, Alexandria, VA
3Express Scripts, Franklin Lakes, NJ.
4Tulane University Health Sciences Center, New Orleans, LA
5Division of Research, Kaiser Permanente Northern California, Oakland, CA
6University of Michigan Medical School, Ann Arbor, MI
7Research and Evaluation Analytics, LLC, Ringwood, NJ.

Tóm tắt

OBJECTIVE Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications. RESEARCH DESIGN AND METHODS We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence. RESULTS Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent. CONCLUSIONS Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence.

Từ khóa


Tài liệu tham khảo

Asche, 2011, A review of diabetes treatment adherence and the association with clinical and economic outcomes, Clin Ther, 33, 74, 10.1016/j.clinthera.2011.01.019

Pladevall, 2004, Clinical outcomes and adherence to medications measured by claims data in patients with diabetes, Diabetes Care, 27, 2800, 10.2337/diacare.27.12.2800

Ho, 2006, Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease, BMC Cardiovasc Disord, 6, 48, 10.1186/1471-2261-6-48

Bogner, 2013, Measuring concurrent oral hypoglycemic and antidepressant adherence and clinical outcomes, Am J Manag Care, 19, e85

Sokol, 2005, Impact of medication adherence on hospitalization risk and healthcare cost, Med Care, 43, 521, 10.1097/01.mlr.0000163641.86870.af

Juarez, 2013, Factors affecting sustained medication adherence and its impact on health care utilization in patients with diabetes, J Pharm Health Serv Res, 4, 89, 10.1111/jphs.12016

Hong, 2011, Relationship between oral antihyperglycemic medication adherence and hospitalization, mortality, and healthcare costs in adult ambulatory care patients with type 2 diabetes in South Korea, Med Care, 49, 378, 10.1097/MLR.0b013e31820292d1

Breitscheidel, 2010, Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: a review paper, J Med Econ, 13, 8, 10.3111/13696990903479199

Hansen, 2010, A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the United States from 2003 to 2005, Clin Ther, 32, 1308, 10.1016/j.clinthera.2010.07.011

Cramer, 2004, A systematic review of adherence with medications for diabetes, Diabetes Care, 27, 1218, 10.2337/diacare.27.5.1218

Peterson, 2007, A checklist for medication compliance and persistence studies using retrospective databases, Value Health, 10, 3, 10.1111/j.1524-4733.2006.00139.x

Hess, 2006, Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures, Ann Pharmacother, 40, 1280, 10.1345/aph.1H018

Karve, 2009, Good and poor adherence: optimal cut-point for adherence measures using administrative claims data, Curr Med Res Opin, 25, 2303, 10.1185/03007990903126833

SAS Institute Inc, 2011, Base SAS 9.3

Rolnick, 2013, Patient characteristics associated with medication adherence, Clin Med Res, 11, 54, 10.3121/cmr.2013.1113

Guénette, 2013, Difficulty adhering to antidiabetic treatment: factors associated with persistence and compliance, Diabetes Metab, 39, 250, 10.1016/j.diabet.2012.12.005

Rodriguez, 2013, Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease: findings from the REACH Registry, Clin Cardiol, 36, 721, 10.1002/clc.22217

Manteuffel, 2014, Influence of patient sex and 4 on medication use, adherence, and prescribing alignment with guidelines, J Womens Health (Larchmt), 112, 10.1089/jwh.2012.3972

van Bruggen, 2009, Refill adherence and polypharmacy among patients with type 2 diabetes in general practice, Pharmacoepidemiol Drug Saf, 18, 983, 10.1002/pds.1810

Schmittdiel, 2011, The comparative effectiveness of mail order pharmacy use vs. local pharmacy use on LDL-C control in new statin users, J Gen Intern Med, 26, 1396, 10.1007/s11606-011-1805-7

Duru, 2010, Mail-order pharmacy use and adherence to diabetes-related medications, Am J Manag Care, 16, 33

Sharma, 2012, Pharmacy effect on adherence to antidiabetic medications, Med Care, 50, 685, 10.1097/MLR.0b013e318249d800

Curkendall, 2013, Predictors of medication adherence in patients with type 2 diabetes mellitus, Curr Med Res Opin, 29, 1275, 10.1185/03007995.2013.821056

Iyengar, 2014, Association between dispensing channel and medication adherence among medicare beneficiaries taking medications to treat diabetes, high blood pressure, or high blood cholesterol, J Manag Care Pharm, 20, 851, 10.18553/jmcp.2014.20.8.851

Ellis, 2004, Suboptimal statin adherence and discontinuation in primary and secondary prevention populations, J Gen Intern Med, 19, 638, 10.1111/j.1525-1497.2004.30516.x

Tseng, 2008, Race/ethnicity and economic differences in cost-related medication underuse among insured adults with diabetes: the Translating Research Into Action for Diabetes Study, Diabetes Care, 31, 261, 10.2337/dc07-1341

Chen, 2013, Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis, Med Care, 51, 231, 10.1097/MLR.0b013e31827da5b9

Shrank, 2010, The epidemiology of prescriptions abandoned at the pharmacy, Ann Intern Med, 153, 633, 10.7326/0003-4819-153-10-201011160-00005

Thông tin
Thông tin xuất bản

Diabetes Care

Tập 38 Số 4

604-609

Thông tin tác giả