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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Dissonance among treatment algorithms for hyperglycemia in type 2 diabetes: an egalitarian dialog. J Endocrinol Invest 2019; 42:237-242. [PMID: 29704235 DOI: 10.1007/s40618-018-0893-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
| | - M I Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
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Liu LH, Fevrier HB, Goldfien R, Hemmerling A, Herrinton LJ. Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus. J Rheumatol 2019; 46:1309-1315. [DOI: 10.3899/jrheum.180946] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 01/06/2023]
Abstract
Objective.Hydroxychloroquine (HCQ) is a cornerstone to managing systemic lupus erythematosus (SLE), yet adherence to medication is poor. We sought to measure the association of adherence with 5 “dimensions of adherence” as articulated by the World Health Organization for chronic conditions: the patient’s socioeconomic status, and patient-, condition-, therapy-, and healthcare system–related factors. Our longterm goal is to generate evidence to design effective interventions to increase adherence.Methods.The retrospective cohort study included Kaiser Permanente Northern California patients ≥ 18 years old during 2006–2014, with SLE and ≥ 2 consecutive prescriptions for HCQ. Adherence was calculated from the medication possession ratio and dichotomized as < 80% versus ≥ 80%. Predictor variables were obtained from the electronic medical record and census data. We used multivariable logistic regression to estimate adjusted OR and 95% CI.Results.The study included 1956 patients. Only 58% of patients had adherence ≥ 80%. In adjusted analyses, socioeconomic variables did not predict adherence. Increasing age (65–89 yrs compared with ≤ 39 yrs: OR 1.44, 95% CI 1.07–1.93), white race (p < 0.05), and the number of rheumatology visits in the year before baseline (≥ 3 compared with 0 or 1: OR 1.47, 95% CI 1.18–1.83) were positively associated with adherence. The rheumatologist and medical center providing care were not associated with adherence.Conclusion.At our setting, as in other settings, about half of patients with SLE were not adherent to HCQ therapy. Differences in adherence by race/ethnicity suggest the possibility of using tailored interventions to increase adherence. Qualitative research is needed to elucidate patient preferences for adherence support.
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253
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Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid/Long-Acting β-Agonist for Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1488-1496.e7. [PMID: 30639604 DOI: 10.1016/j.jaip.2018.12.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization have not been performed. OBJECTIVE To compare similar patients with asthma initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR). METHODS This was a retrospective cohort study of commercial and Medicare Advantage with Part D enrollees initiating FF/VI or BUD/F for asthma. Adult patients (≥18 years) with at least 15-month (12-month preindex and 3-month postindex) continuous enrollment and 1 or more asthma diagnosis code were eligible for the study. Patients with a history of fixed-dose inhaled corticosteroid/long-acting β-agonist and other respiratory disorders (chronic obstructive pulmonary disease, cystic fibrosis, acute respiratory failure) in the baseline period were excluded. Propensity-score matching was used to balance cohorts on baseline characteristics. Logistic regression and Cox-proportional hazard models were used to assess differences. RESULTS A total of 9951 patients met all criteria. After propensity-score matching, 1725 patients were matched in each cohort. Subjects who initiated FF/VI had a significantly higher mean proportion of days covered (P < .001), had 86% greater odds of having a proportion of days covered value of greater than or equal to 0.80 (adjusted odds ratio, 1.86; 95% CI, 1.51-2.30), 26% lower risk of discontinuation (adjusted hazard ratio, 0.74; 95% CI, 0.69-0.79), and 36% greater odds of an AMR of greater than or equal to 0.50 (adjusted odds ratio, 1.36; 95% CI, 1.23-1.50) compared with BUD/F. CONCLUSIONS Adherence and treatment persistence were low in both cohorts; however, patients initiating once-daily FF/VI were more likely to be adherent, have an AMR of greater than or equal to 0.5, and were less likely to discontinue therapy compared with patients initiating twice-daily BUD/F (GlaxoSmithKline Study HO1617302/206482).
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254
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Cutler RL, Torres-Robles A, Wiecek E, Drake B, Van der Linden N, Benrimoj SI(C, Garcia-Cardenas V. Pharmacist-led medication non-adherence intervention: reducing the economic burden placed on the Australian health care system. Patient Prefer Adherence 2019; 13:853-862. [PMID: 31213779 PMCID: PMC6537038 DOI: 10.2147/ppa.s191482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Scarcity of prospective medication non-adherence cost measurements for the Australian population with no directly measured estimates makes determining the burden medication non-adherence places on the Australian health care system difficult. This study aims to indirectly estimate the national cost of medication non-adherence in Australia comparing the cost prior to and following a community pharmacy-led intervention. Methods: Retrospective observational study. A de-identified database of dispensing data from 20,335 patients (n=11,257 on rosuvastatin, n=6,797 on irbesartan and n=2,281 on desvenlafaxine) was analyzed and average adherence rate determined through calculation of PDC. Included patients received a pharmacist-led medication adherence intervention and had twelve months dispensing records; six months before and six months after the intervention. The national cost estimate of medication non-adherence in hypertension, dyslipidemia and depression pre- and post-intervention was determined through utilization of disease prevalence and comorbidity, non-adherence rates and per patient disease-specific adherence-related costs. Results: The total national cost of medication non-adherence across three prevalent conditions, hypertension, dyslipidemia and depression was $10.4 billion equating to $517 per adult. Following enrollment in the pharmacist-led intervention medication non-adherence costs per adult decreased $95 saving the Australian health care system and patients $1.9 billion annually. Conclusion: In the absence of a directly measured national cost of medication non-adherence, this estimate demonstrates that pharmacists are ideally placed to improve patient adherence and reduce financial burden placed on the health care system due to non-adherence. Funding of medication adherence programs should be considered by policy and decision makers to ease the current burden and improve patient health outcomes moving forward.
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Affiliation(s)
- Rachelle Louise Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Correspondence: Rachelle Louise CutlerGraduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW2007, AustraliaTel +61 29 514 7187Email
| | - Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Barry Drake
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
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255
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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256
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Yoon EL, Cheong WL. Adherence to oral disease-modifying therapy in multiple sclerosis patients: A systematic review. Mult Scler Relat Disord 2018; 28:104-108. [PMID: 30590239 DOI: 10.1016/j.msard.2018.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/25/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Ee Ling Yoon
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon, Selatan, 47500 Bandar Sunway. Selangor Darul Ehsan, Malaysia.
| | - Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon, Selatan, 47500 Bandar Sunway. Selangor Darul Ehsan, Malaysia.
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257
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Wastesson JW, Morin L, Laroche ML, Johnell K. How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study. J Am Geriatr Soc 2018; 67:455-462. [PMID: 30575952 DOI: 10.1111/jgs.15717] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/04/2018] [Accepted: 11/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the chronicity of polypharmacy among older adults and to identify factors associated with chronic polypharmacy. DESIGN Longitudinal cohort study using register data. SETTING Nationwide, Sweden. PARTICIPANTS All 711,432 older adults (aged 65 years and older) living in Sweden with five or more prescription drugs in October 2010 were included and followed up until December 2013. Mean age at baseline was 77 (SD = 7.8) years, 59% were women, and 7% lived in nursing homes. MEASUREMENT Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register. RESULTS Overall, 82% were continuously exposed to polypharmacy for 6 months or longer, and 74% for 12 months or longer. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (ie, with a new episode of polypharmacy), only 30% remained exposed for 6 months or longer. The proportion of older adults who spent at least 80% of their follow-up time with polypharmacy was substantially higher among prevalent polypharmacy users at baseline than among those with a new polypharmacy episode (80% vs 24%; P < .01). Factors associated with chronic polypharmacy included higher age, female sex, living in an institution, chronic multimorbidity, and multidose dispensing. CONCLUSION Polypharmacy is most often chronic, although a substantial share of older adults experience short, recurring episodes of polypharmacy and are thus exposed to its potential harms in a transient rather than persistent manner. J Am Geriatr Soc 67:455-462, 2019.
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Affiliation(s)
- Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marie-Laure Laroche
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France.,INSERM 1248, Faculté de Médecine, Université de Limoges, Limoges, France
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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258
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Rodríguez-Bernal CL, García-Sempere A, Hurtado I, Santa-Ana Y, Peiró S, Sanfélix-Gimeno G. Real-world adherence to oral anticoagulants in atrial fibrillation patients: a study protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e025102. [PMID: 30573490 PMCID: PMC6303591 DOI: 10.1136/bmjopen-2018-025102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is one of the leading causes of cerebrovascular mortality and morbidity. Oral anticoagulants (OACs) have been shown to reduce the incidence of cardioembolic stroke in patients with AF, adherence to treatment being an essential element for their effectiveness. Since the release of the first non-vitamin K antagonist oral anticoagulant, several observational studies have been carried out to estimate OAC adherence in the real world using pharmacy claim databases or AF registers. This systematic review aims to describe secondary adherence to OACs, to compare adherence between OACs and to analyse potential biases in OAC secondary adherence studies using databases. METHODS AND ANALYSIS We searched on PubMed, SCOPUS and Web of Science databases (completed in 26 September 2018) to identify longitudinal observational studies reporting days' supply adherence measures with OAC in patients with AF from refill databases or AF registers. The main study endpoint will be the percentage of patients exceeding the 80% threshold in proportion of days covered or the medication possession ratio. Two reviewers will independently screen potential studies and will extract data in a structured format. A random-effects meta-analysis will be carried out to pool study estimates. The risk of bias will be assessed using the Newcastle-Ottawa Scale for observational studies and we will also assess some study characteristics that could affect days' supply adherence estimates. ETHICS AND DISSEMINATION This systematic review using published aggregated data does not require ethics approval according to Spanish law and international regulations. The final results will be published in a peer-review journal and different social stakeholders, non-academic audiences and patients will be incorporated into the diffusion activities. PROSPERO REGISTRATION NUMBER CRD42018095646.
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Affiliation(s)
- Clara L Rodríguez-Bernal
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Aníbal García-Sempere
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Isabel Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Yared Santa-Ana
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Khunti K, Danese MD, Kutikova L, Catterick D, Sorio-Vilela F, Gleeson M, Kondapally Seshasai SR, Brownrigg J, Ray KK. Association of a Combined Measure of Adherence and Treatment Intensity With Cardiovascular Outcomes in Patients With Atherosclerosis or Other Cardiovascular Risk Factors Treated With Statins and/or Ezetimibe. JAMA Netw Open 2018; 1:e185554. [PMID: 30646277 PMCID: PMC6324347 DOI: 10.1001/jamanetworkopen.2018.5554] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Both adherence and treatment intensity can alter the effectiveness of lipid-lowering therapy in routine clinical practice. OBJECTIVE To evaluate the association of adherence and treatment intensity with cardiovascular outcomes in patients with documented cardiovascular disease (CVD), type 2 diabetes without CVD or chronic kidney disease (CKD), and CKD without CVD. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using the Clinical Practice Research Datalink from January 2010 through February 2016. United Kingdom primary care was the setting. Participants were newly treated patients who received their first statin and/or ezetimibe prescription between January 1, 2010, and December 31, 2013, plus an additional prescription for statins and/or ezetimibe during the following year. EXPOSURES Adherence was assessed annually using the proportion of days covered, with adherent defined as a proportion of days covered of 80% or higher. Treatment intensity was classified according to guidelines based on the expected percentage of low-density lipoprotein cholesterol (LDL-C) reduction as low (<30% reduction), moderate (30% to <50% reduction), or high (≥50% reduction). Adherence and treatment intensity were multiplied to create a combined measure, reflecting treatment intensity after accounting for adherence. MAIN OUTCOMES AND MEASURES Composite end point of cardiovascular death or hospitalization for myocardial infarction, unstable angina, ischemic stroke, heart failure, or revascularization. Hazard ratios (HRs) were estimated against patients not treated for 1 year or longer. RESULTS Among a total of 29 797 newly treated patients, there were 16 701, 12 422, and 674 patients with documented CVD, type 2 diabetes without CVD or CKD, and CKD without CVD, respectively; mean (SD) ages were 68.3 (13.2), 59.3 (12.4), and 67.3 (15.1) years, and male proportions were 60.6%, 55.0%, and 47.0%. In the documented CVD cohort, patients receiving high-intensity therapy were more likely to be adherent over time (84.1% in year 1 and 72.3% in year 6) than patients receiving low-intensity therapy (57.4% in year 1 and 48.4% in year 6). Using a combined measure of adherence and treatment intensity, a graded association was observed with both LDL-C reduction and CVD outcomes: each 10% increase in the combined measure was associated with a 10% lower risk (HR, 0.90; 95% CI, 0.86-0.94). Adherent patients receiving a high-intensity regimen had the lowest risk (HR, 0.60; 95% CI, 0.54-0.68) vs patients untreated for 1 year or longer. Findings in the other 2 cohorts were similar. CONCLUSIONS AND RELEVANCE Results of this study demonstrate that the lowest cardiovascular risk was observed among adherent patients receiving high-intensity therapy, and the highest cardiovascular risk was observed among nonadherent patients receiving low-intensity therapy. Strategies that improve adherence and greater use of intensive therapies could substantially improve cardiovascular risk.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Mark D. Danese
- Outcomes Research, Outcomes Insights, Inc, Westlake Village, California
| | | | | | | | - Michelle Gleeson
- Outcomes Research, Outcomes Insights, Inc, Westlake Village, California
| | | | - Jack Brownrigg
- St George’s Vascular Institute, London, United Kingdom
- currently with Rare Diseases, Pfizer, London, United Kingdom
| | - Kausik K. Ray
- currently with Rare Diseases, Pfizer, London, United Kingdom
- Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, United Kingdom
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Ofori-Asenso R, Ilomaki J, Tacey M, Curtis AJ, Zomer E, Bell JS, Zoungas S, Liew D. Prevalence and Incidence of Statin Use and 3-Year Adherence and Discontinuation Rates Among Older Adults With Dementia. Am J Alzheimers Dis Other Demen 2018; 33:527-534. [PMID: 29991271 PMCID: PMC10852509 DOI: 10.1177/1533317518787314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the patterns of statin use and determine the 3-year adherence and discontinuation rates among a cohort of Australians aged ≥65 years with dementia. METHODS The yearly prevalence and incidence of statin use were compared via Poisson regression modeling using 2007 as the reference year. People with dementia were identified according to dispensing of antidementia medications. A cohort of 589 new statin users was followed longitudinally. Adherence was estimated via the proportion of days covered (PDC). Discontinuation was defined as ≥90 days without statin coverage. RESULTS The annual prevalence of statin use among older Australians with dementia increased from 20.6% in 2007 to 31.7% in 2016 (aged-sex adjusted rate ratio: 1.51, 95% confidence interval: 1.35-1.69). Among the new users, the proportion adherent (PDC ≥ 0.80) decreased from 60.3% at 6 months to 31.0% at 3 years. During the 3-year follow-up, 58.7% discontinued their statin. CONCLUSIONS Despite increased use of statins among older Australians with dementia, adherence is low and discontinuation is high, which may point to intentional cessation.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing, and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ella Zomer
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Sophia Zoungas
- Division of Metabolism, Ageing, and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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261
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Wheeler AJ, Spinks J, Kelly F, Ware RS, Vowles E, Stephens M, Scuffham PA, Miller A. Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia. BMJ Open 2018; 8:e026462. [PMID: 30391923 PMCID: PMC6231589 DOI: 10.1136/bmjopen-2018-026462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers. METHODS AND ANALYSIS This study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure. ETHICS AND DISSEMINATION The protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12618000188235; Pre-results.
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Affiliation(s)
- Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand
| | - Jean Spinks
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Fiona Kelly
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Erica Vowles
- The Pharmacy Guild of Australia, National Secretariat, Canberra, Australian Capital Territory, Australia
| | - Mike Stephens
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Adrian Miller
- Office of the Pro Vice-Chancellor Indigenous Engagement, CQ University, Townsville, Queensland, Australia
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262
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Abstract
Nonadherence to prescribed medications poses a significant public health problem. Prescription data in electronic medical records (EMRs) linked with pharmacy claims data provides an opportunity to examine the prescription fill rates and factors associated with it.Using a claims-EMR linked data, patients who had a prescription for either an antibiotic, antihypertensive, or antidiabetic in EMR were identified (index prescription). Prescription fill was defined as a pharmacy claim found within the 90 days following the EMR prescription. For each medication group, patient characteristics and fill rates were examined using descriptive statistics. Multivariate logistic regression was used to evaluate the association between fill rates and factors such as age, race, brand vs generic, and prior treatment during 365 days before the index date.Among 77,996 patients with index antibiotic prescription, 78,462 with index antihypertensive prescription, and 24,013 with index antidiabetic prescription, the prescription fill rate was 73%, 74%, and 76%, respectively. Overall, African American race was negatively associated with fill rates (odds ratio [OR] 0.8 for all 3 groups). Prior treatment history was positively associated with antihypertensives (OR 5.6, 95% confidence interval [CI] 5.4-5.7) or antidiabetics (OR 4.1, CI 3.8-4.4) but negatively with antibiotics (OR 0.6, CI 0.6-0.6). Older age was an additional factor that was negatively associated with first time fill rate among patients without prior treatment.Significant proportions of patients, especially patients with no prior treatment history, did not fill prescriptions for antibiotics, antihypertensives, or antidiabetics. The association between patient factors and medication fill rates varied across different medication groups.
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263
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Humenberger M, Horner A, Labek A, Kaiser B, Frechinger R, Brock C, Lichtenberger P, Lamprecht B. Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD). BMC Pulm Med 2018; 18:163. [PMID: 30340565 PMCID: PMC6194635 DOI: 10.1186/s12890-018-0724-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/18/2018] [Indexed: 12/24/2022] Open
Abstract
Background COPD is a treatable disease with increasing prevalence worldwide. Treatment aims to stop disease progression, to improve quality of life, and to reduce exacerbations. We aimed to evaluate the association of the stage of COPD on adherence to inhaled therapy and the relationship between adherence and COPD exacerbations. Methods A retrospective analysis of patients hospitalized for acute exacerbation of COPD in a tertiary care hospital in Upper Austria and discharged with a guideline conform inhaled therapy was performed. Follow-up data on medical utilization was recorded for the subsequent 24 months. Adherence to inhaled therapy was defined according to the percentage of prescribed inhalers dispensed to the patient and classified as complete (> 80%), partial (50–80%) or low (< 50%). Results Out of 357 patients, 65.8% were male with a mean age of 66.5 years and a mean FEV1 of 55.0%pred. Overall, 35.3% were current smokers, and only 3.9% were never-smokers. In 77.0% inhaled triple therapy (LAMA + LABA + ICS) was prescribed. 33.6% showed complete adherence to their therapy (33.2% in men, 34.4% in women), with a mean age of 67.0 years. Mean medication possession ratio by GOLD spirometry class I – IV were 0.486, 0.534, 0.609 and 0.755, respectively (p = 0.002). Hence, subjects with complete adherence to therapy had a significantly lower FEV1 compared to those with low adherence (49.2%pred. vs 59.2%pred., respectively; p < 0.001). The risk of exacerbations leading to hospitalization was 10-fold higher in GOLD spirometry class IV compared to GOLD spirometry class I, which was even more evident in multivariate analysis (OR 13.62). Conclusion Complete adherence to inhaled therapy was only seen in 33.6% and was higher among those with more severe COPD. Trial registration Not applicable.
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Affiliation(s)
- Magdalena Humenberger
- Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria.,Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Andreas Horner
- Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria. .,Faculty of Medicine, Johannes-Kepler-University, Linz, Austria.
| | - Anna Labek
- Department of Health Economics, Upper Austrian Health Insurance, Linz, Austria
| | - Bernhard Kaiser
- Department of Health Economics, Upper Austrian Health Insurance, Linz, Austria
| | - Rupert Frechinger
- Department of Medical Controlling, Kepler University Hospital, Linz, Austria
| | - Constanze Brock
- Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria
| | - Petra Lichtenberger
- Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria.,Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
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264
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Jacobs MS, Schouten JF, de Boer PT, Hoffmann M, Levin LÅ, Postma MJ. Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands. Curr Med Res Opin 2018; 34:1839-1847. [PMID: 29598152 DOI: 10.1080/03007995.2018.1459528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation. METHODS Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen. RESULTS A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]). LIMITATIONS The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded. CONCLUSIONS This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.
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Affiliation(s)
- Maartje S Jacobs
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
- b Department of Clinical Pharmacy and Toxicology , Martini Hospital , Groningen , The Netherlands
| | - Jeroen F Schouten
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
| | - Pieter T de Boer
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
| | - Mikael Hoffmann
- c Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Lars-Åke Levin
- c Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Maarten J Postma
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
- d Institute for Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen , Groningen , The Netherlands
- e Department of Epidemiology , University Medical Center Groningen , Groningen , The Netherlands
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265
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Romanelli RJ, Huang Q, LaMori J, Doshi D, Chung S. Patients' Medication-Related Experience of Care Is Associated with Adherence to Cardiometabolic Disease Therapy in Real-World Clinical Practice. Popul Health Manag 2018; 21:409-414. [DOI: 10.1089/pop.2017.0163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert J. Romanelli
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Qiwen Huang
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Joyce LaMori
- Janssen Scientific Affairs, Titusville, New Jersey
| | - Dilesh Doshi
- Janssen Scientific Affairs, Titusville, New Jersey
| | - Sukyung Chung
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
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266
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Medication Adherence and Discontinuation of Aripiprazole Once-Monthly 400 mg (AOM 400) Versus Oral Antipsychotics in Patients with Schizophrenia or Bipolar I Disorder: A Real-World Study Using US Claims Data. Adv Ther 2018; 35:1612-1625. [PMID: 30206822 PMCID: PMC6182631 DOI: 10.1007/s12325-018-0785-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Indexed: 12/03/2022]
Abstract
Introduction Few studies have compared adherence between long-acting injectable antipsychotics, especially for newer agents like aripiprazole once-monthly 400 mg (AOM 400; aripiprazole monohydrate) and oral antipsychotics, in patients with schizophrenia or bipolar I disorder (BD-I) in a real-world setting. Methods Two separate retrospective cohort analyses using Truven MarketScan data from January 1, 2012 to June 30, 2016 were conducted to compare medication adherence and discontinuation in patients with schizophrenia or BD-I who initiated treatment with AOM 400 vs. patients changed from one oral antipsychotic monotherapy to another. Adherence was defined as proportion of days covered (PDC) ≥ 0.80 in the year following the index date. Linear regression models examined the association between AOM 400 and oral antipsychotic cohorts and medication adherence. Kaplan–Meier curves and Cox regression estimated time to and risk of discontinuation, while adjusting for baseline covariates. A sensitivity analysis was conducted using a combination of propensity score matching and exact matching to create matched cohorts. Results Final cohort sizes were as follows—Schizophrenia: AOM 400 n = 408, oral antipsychotic n = 3361; BD-I: AOM 400 n = 413, oral antipsychotic n = 15,534. In patients with schizophrenia, adjusted mean PDC was higher in patients in the AOM 400 cohort vs. the oral antipsychotic cohort (0.57 vs. 0.48 P < 0.001), and patients in the oral antipsychotic cohort had a higher risk of discontinuing treatment vs. the AOM 400 cohort (HR 1.45, 95% CI 1.29–1.64). For patients with BD-I, adjusted mean PDC was higher for the AOM 400 cohort (0.59 vs. 0.44, P < 0.001), and patients in the oral antipsychotic cohort had a higher risk of discontinuation (HR 1.71, 95% CI 1.53–1.92). Conclusions In a real-word setting, AOM 400 resulted in a significantly higher percentage of patients with a PDC ≥ 0.80 and significantly longer time to treatment discontinuation compared to patients with schizophrenia or BD-I who received treatment with an oral antipsychotic. Funding Otsuka Pharmaceutical Development and Commercialization, Inc. and Lundbeck. Electronic supplementary material The online version of this article (10.1007/s12325-018-0785-y) contains supplementary material, which is available to authorized users.
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Prada-Ramallal G, Roque F, Herdeiro MT, Takkouche B, Figueiras A. Primary versus secondary source of data in observational studies and heterogeneity in meta-analyses of drug effects: a survey of major medical journals. BMC Med Res Methodol 2018; 18:97. [PMID: 30261846 PMCID: PMC6161342 DOI: 10.1186/s12874-018-0561-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background The data from individual observational studies included in meta-analyses of drug effects are collected either from ad hoc methods (i.e. “primary data”) or databases that were established for non-research purposes (i.e. “secondary data”). The use of secondary sources may be prone to measurement bias and confounding due to over-the-counter and out-of-pocket drug consumption, or non-adherence to treatment. In fact, it has been noted that failing to consider the origin of the data as a potential cause of heterogeneity may change the conclusions of a meta-analysis. We aimed to assess to what extent the origin of data is explored as a source of heterogeneity in meta-analyses of observational studies. Methods We searched for meta-analyses of drugs effects published between 2012 and 2018 in general and internal medicine journals with an impact factor > 15. We evaluated, when reported, the type of data source (primary vs secondary) used in the individual observational studies included in each meta-analysis, and the exposure- and outcome-related variables included in sensitivity, subgroup or meta-regression analyses. Results We found 217 articles, 23 of which fulfilled our eligibility criteria. Eight meta-analyses (8/23, 34.8%) reported the source of data. Three meta-analyses (3/23, 13.0%) included the method of outcome assessment as a variable in the analysis of heterogeneity, and only one compared and discussed the results considering the different sources of data (primary vs secondary). Conclusions In meta-analyses of drug effects published in seven high impact general medicine journals, the origin of the data, either primary or secondary, is underexplored as a source of heterogeneity. Electronic supplementary material The online version of this article (10.1186/s12874-018-0561-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guillermo Prada-Ramallal
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain.,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Fatima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (Unidade de Investigação para o Desenvolvimento do Interior - UDI/IPG), 6300-559, Guarda, Portugal.,Health Sciences Research Centre, University of Beira Interior (Centro de Investigação em Ciências da Saúde - CICS/UBI), 6200-506, Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences & Institute for Biomedicine - iBiMED, University of Aveiro, 3810-193, Aveiro, Portugal.,Higher Polytechnic & University Education Co-operative (Cooperativa de Ensino Superior Politécnico e Universitário - CESPU), Institute for Advanced Research & Training in Health Sciences & Technologies, 4585-116, Gandra, Portugal
| | - Bahi Takkouche
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain.,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain. .,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706, Santiago de Compostela, Spain. .,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain.
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268
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Maggioni AP, Dondi L, Pedrini A, Ronconi G, Calabria S, Cimminiello C, Martini N. The use of antiplatelet agents after an acute coronary syndrome in a large community Italian setting of more than 12 million subjects. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:527-535. [PMID: 30209955 DOI: 10.1177/2048872618801252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antiplatelet agents are the cornerstone of medical treatment in acute coronary syndromes. The aim of this study was to evaluate the clinical epidemiology of patients after an acute coronary syndrome treated with different antiplatelet agent regimens in a large real community setting. METHODS The ARCO database, including more than 12 million inhabitants, was evaluated. Antiplatelet agent prescriptions were analysed as follows: aspirin, clopidogrel, other antiplatelet agents used alone; the free and fixed combination of clopidogrel and aspirin; the free combination of aspirin with other antiplatelet agents. Healthcare costs included drug prescriptions (prices reimbursed by the Italian National Health System), outpatient specialist services and hospitalisations (Italian national tariffs). RESULTS From 1 January to 31 December 2014, 26,834 patients were discharged after an acute coronary syndrome. Of these, 19,333 (77%) were prescribed with an antiplatelet agent. Among patients undergoing a revascularisation procedure either percutaneous or surgical (47% of the total population), antiplatelet agents were prescribed in 90% of cases. Dual antiplatelet agent therapy was prescribed in 49.6% of the total population and in 68.5% of those treated invasively. Prescription continuity was observed in just 75% of patients. The highest adherence was observed for the fixed combination of aspirin/clopidogrel (81.5%). Throughout one year of follow-up re-hospitalisation occurred in 47.9% of the patients and the direct cost per patient treated with an antiplatelet agent was €13,297 versus €16,647 in patients not treated with antiplatelet agents. CONCLUSIONS This study highlights that antiplatelet agent prescriptions, specifically dual antiplatelet agent therapy, are at least suboptimal as well as in prescription continuity. Hospitalisations were frequent and were the main driver of the costs, accounting for 84% of the total costs for the Italian National Health System.
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Affiliation(s)
| | | | | | | | | | - Claudio Cimminiello
- Studies and Research Center, Italian Society of Angiology and Vascular Medicine (Società Italiana di Angiologia e Patologia Vascolare), Italy
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Arnet I, Greenland M, Knuiman MW, Rankin JM, Hung J, Nedkoff L, Briffa TG, Sanfilippo FM. Operationalization and validation of a novel method to calculate adherence to polypharmacy with refill data from the Australian pharmaceutical benefits scheme (PBS) database. Clin Epidemiol 2018; 10:1181-1194. [PMID: 30233252 PMCID: PMC6132235 DOI: 10.2147/clep.s153496] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Electronic health care data contain rich information on medicine use from which adherence can be estimated. Various measures developed with medication claims data called for transparency of the equations used, predominantly because they may overestimate adherence, and even more when used with multiple medications. We aimed to operationalize a novel calculation of adherence with polypharmacy, the daily polypharmacy possession ratio (DPPR), and validate it against the common measure of adherence, the medication possession ratio (MPR) and a modified version (MPRm). Methods We used linked health data from the Australian Pharmaceutical Benefits Scheme and Western Australian hospital morbidity dataset and mortality register. We identified a strict study cohort from 16,185 patients aged ≥65 years hospitalized for myocardial infarction in 2003–2008 in Western Australia as an illustrative example. We applied iterative exclusion criteria to standardize the dispensing histories according to previous literature. A SAS program was developed to calculate the adherence measures accounting for various drug parameters. Results The study cohort was 348 incident patients (mean age 74.6±6.8 years; 69% male) with an admission for myocardial infarction who had cardiovascular medications over a median of 727 days (range 74 to 3,798 days) prior to readmission. There were statins (96.8%), angiotensin converting enzyme inhibitors (88.8%), beta-blockers (85.6%), and angiotensin receptor blockers (13.2%) dispensed. As expected, observed adherence values were higher with mean MPR (median 89.2%; Q1: 73.3%; Q3: 104.6%) than mean MPRm (median 82.8%; Q1: 68.5%; Q3: 95.9%). DPPR values were the most narrow (median 83.8%; Q1: 70.9%; Q3: 96.4%). Mean MPR and DPPR yielded very close possession values for 37.9% of the patients. Values were similar in patients with longer observation windows. When the traditional threshold of 80% was applied to mean MPR and DPPR values to signify the threshold for good adherence, 11.6% of patients were classified as good adherers with the mean MPR relative to the DPPR. Conclusion In the absence of transparent and standardized equations to calculate adherence to polypharmacy from refill databases, the novel DPPR algorithm represents a valid and robust method to estimate medication possession for multi-medication regimens.
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Affiliation(s)
- Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Melanie Greenland
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia,
| | - Matthew W Knuiman
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia,
| | - Jamie M Rankin
- Cardiology Department, Fiona Stanley Hospital Murdoch, WA, Australia
| | - Joe Hung
- School of Medicine, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Lee Nedkoff
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia,
| | - Tom G Briffa
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia,
| | - Frank M Sanfilippo
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia,
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270
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Ganguly R, Tian Y, Kong SX, Hersloev M, Hobbs T, Smolarz BG, Ramasamy A, Haase CL, Weng W. Persistence of newer anti-obesity medications in a real-world setting. Diabetes Res Clin Pract 2018; 143:348-356. [PMID: 30009937 DOI: 10.1016/j.diabres.2018.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
Abstract
AIMS Evaluate real-world data on persistence with anti-obesity medications (AOMs) and explore associated patient factors. METHODS Truven Health MarketScan® data were analyzed to evaluate utilization of AOMs approved for long-term use between 4/2015 and 3/2016. Kaplan-Meier survival analyses were used to evaluate treatment persistence. A multivariate analysis was performed to identify associations between persistence and relevant factors. RESULTS In total, 26,522 adult patients were identified as newly prescribed naltrexone/bupropion (44.0%, mean age 47.1, 80.5% female), lorcaserin (24.8%, 48.5, 79.3%), phentermine/topiramate extended release (15.8%, 46.7, 82.2%) or liraglutide 3.0 mg (15.4%, 46.9, 72.4%). At 6 months, 41.8% of patients were still on liraglutide 3.0 mg, compared to 15.9% lorcaserin (p < 0.001), 18.1% naltrexone/bupropion (p < 0.001), and 27.3% phentermine/topiramate (p < 0.001). After adjusting for baseline factors, patients on liraglutide 3.0 mg had significantly lower risk of discontinuation compared to those on lorcaserin (HR = 0.46, p < 0.0001), naltrexone/bupropion (HR = 0.48, p < 0.0001), and phentermine/topiramate (HR = 0.64, p < 0.0001) over the course of follow-up (mean follow-up duration, 342-427 days). Older age, male gender, having hyperlipidemia, and no prior phentermine use were associated with higher persistence. Over 95% of study patients had commercial insurance. CONCLUSIONS In a real-world setting, patients on liraglutide 3.0 mg had the highest persistence rate of the four AOMs studied.
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Affiliation(s)
- Rahul Ganguly
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Ye Tian
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Sheldon X Kong
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Malene Hersloev
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Todd Hobbs
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | | | | | | | - Wayne Weng
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA.
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271
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Nichols GA, Raebel MA, Dyer W, Schmittdiel JA. The Effect of Age and Comorbidities on the Association Between the Medicare STAR Oral Antihyperglycemic Adherence Metric and Glycemic Control. J Manag Care Spec Pharm 2018; 24:856-861. [PMID: 30156449 PMCID: PMC10398005 DOI: 10.18553/jmcp.2018.24.9.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Medicare STAR program for Medicare Advantage Plans that include drug benefits provides monetary incentives for health plans to achieve good adherence to oral antihyperglycemic (OAH) agents but does not account for differential case mix that could affect the ability of health plans to achieve the required quality metrics. OBJECTIVE To determine whether OAH adherence varies by age and comorbidities among patients aged 65 years or older and the extent to which adherence affects glycemic control across age and comorbidity strata. METHODS We studied 54,480 patients with diabetes aged > 65 years from the Colorado, Northwest, and Northern California regions of Kaiser Permanente who received OAH agents but not insulin in 2010. We calculated adherence using the proportion of days covered (PDC) method. Per the STAR program, hemoglobin A1c < 8% defined good glycemic control. We also defined poor control as A1c > 9%. We used modified Poisson regression to identify predictors of adherence and to determine its effects on A1c across age and comorbidity strata, adjusting for sociodemographics and medication-related variables. RESULTS The risk of being adherent to OAH declined moderately with an increasing number of comorbidities (risk ratio [RR] = 0.99, 95% CI = 0.98-1.00 for 1 comorbidity and RR = 0.90, 95% CI = 0.88-0.91 for 4 or more comorbidities). Adherence to OAH agents was associated with a 0%-3% increased risk of A1c < 8% across age and comorbidity categories, as well as a large decreased risk (RR = 0.55-0.73) of A1c > 9% for patients aged < 80 years or with < 3 comorbidities. CONCLUSIONS Among patients with diabetes aged > 65 years, having multiple comorbidities affects adherence. Adherence reduces the risk of poor A1c control among patients aged 65-79 years or with 2 or fewer comorbidities. Our results suggest that health plan case mix minimally influenced the Medicare STAR OAH adherence metric, but it may affect glycemic control quality measures, especially if a HEDIS-like measure of poor control were adopted. DISCLOSURES This study was supported by grant number 1R21DK103146-01A1 from the National Institute of Diabetes and Digestive and Kidney Disorders. Nichols currently receives grant funding from Boehringer-Ingelheim, Sanofi, Amarin Pharma, and Janssen Pharmaceuticals for other unrelated research projects. The other authors declare no conflicts of interest. This study was presented at the American Diabetes Association's 77th Scientific Sessions; June 9-13, 2017; San Diego, CA.
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Affiliation(s)
- Gregory A Nichols
- 1 Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Marsha A Raebel
- 2 Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Wendy Dyer
- 3 Kaiser Permanente Northern California Division of Research, Oakland
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Laius O, Pisarev H, Volmer D, Kõks S, Märtson A, Maasalu K. Use of a national database as a tool to identify primary medication non-adherence: The Estonian ePrescription system. Res Social Adm Pharm 2018; 14:776-783. [DOI: 10.1016/j.sapharm.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
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273
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Flory JH, Keating SJ, Siscovick D, Mushlin AI. Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record. BMJ Open 2018; 8:e021505. [PMID: 30037872 PMCID: PMC6059278 DOI: 10.1136/bmjopen-2018-021505] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Non-persistence may be a significant barrier to the use of metformin. Our objective was to assess reasons for metformin non-persistence, and whether initial metformin dosing or use of extended release (ER) formulations affect persistence to metformin therapy. DESIGN Retrospective cohort study. SETTING Electronic health record data from a network of urban academic practices. PARTICIPANTS The cohort was restricted to individuals receiving a metformin prescription between 2009/1/1 and 2015/9/31, under care for at least 6 months before the first prescription of metformin. The cohort was further restricted to patients with no evidence of any antihyperglycaemic agent use prior to the index date, an haemoglobin A1c measured within 1 month prior to or 1 week after the index date, at least 6 months of follow-up, and with the initial metformin prescription originating in either a general medicine or endocrinology clinic. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was early non-persistence, as defined by the absence of further prescriptions for metformin after the first 90 days of follow-up. RESULTS The final cohort consisted of 1259 eligible individuals. The overall rate of early non-persistence was 20.3%. Initial use of ER and low starting dose metformin were associated with significantly lower rates of reported side effects and non-persistence, but after multivariable analysis, only use of low starting doses was independently associated with improved persistence (adjusted OR 0.54, 95% CI 0.37 to 0.76, for comparison of 500 mg daily dose or less to all higher doses). CONCLUSIONS These data support the routine prescribing of low starting doses of metformin as a tool to improve persistence. In this study setting, many providers routinely used ER metformin as an initial treatment; while this practice may have benefits, it deserves more rigorous study to assess whether increased costs are justified.
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Affiliation(s)
- James H Flory
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
| | - Scott Justin Keating
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
| | | | - Alvin I Mushlin
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
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274
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Murage MJ, Anderson A, Casso D, Oliveria SA, Ojeh CK, Muram TM, Merola JF, Zbrozek A, Araujo AB. Treatment patterns, adherence, and persistence among psoriasis patients treated with biologics in a real-world setting, overall and by disease severity. J DERMATOL TREAT 2018; 30:141-149. [DOI: 10.1080/09546634.2018.1479725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Amanda Anderson
- Epidemiology and Drug Safety, IQVIA, Plymouth Meeting, PA, USA
| | - Deborah Casso
- Epidemiology and Drug Safety, IQVIA, Plymouth Meeting, PA, USA
| | | | | | | | - Joseph F. Merola
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Art Zbrozek
- Eli Lilly and Company, Indianapolis, IN, USA
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275
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Adams AL, Adams JL, Raebel MA, Tang BT, Kuntz JL, Vijayadeva V, McGlynn EA, Gozansky WS. Bisphosphonate Drug Holiday and Fracture Risk: A Population-Based Cohort Study. J Bone Miner Res 2018. [PMID: 29529334 DOI: 10.1002/jbmr.3420] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Holidays from bisphosphonates (BPs) may help to prevent rare adverse events such as atypical femoral fractures, but may be appropriate only if risk of osteoporosis-related fractures does not increase. Our objective was to compare the incidence of osteoporosis-related fractures among women who had a BP holiday to those who continued to use BPs. This retrospective cohort study, conducted within four Kaiser Permanente integrated health system regions, included 39,502 women aged ≥45 years with ≥3 years exposure to BP. Participants with a BP holiday (≥12 months with no use) were compared to persistent (use with ≥50% adherence) and nonpersistent (use with <50% adherence) users for incident osteoporosis-related fractures. The BP holiday (n = 11,497), nonpersistent user (n = 10,882), and persistent user groups (n = 17,123) were observed for 156,657 person-years. A total of 5199 osteoporosis-related fractures (including 1515 hip fractures and 2147 vertebral fractures) were observed. Compared to the persistent use group, there was a slight difference in overall osteoporosis-related fracture risk (HR 0.92; 95% CI, 0.84 to 0.99)and no difference in hip fracture risk (HR 0.95; 95% CI, 0.83 to 1.10) for the BP holiday group. A slight reduction in risk of vertebral fracture was observed (HR 0.83; 95% CI, 0.74 to 0.95). Compared to the nonpersistent user group, the BP holiday group was at decreased risk for osteoporosis-related fractures (HR 0.71; 95% CI, 0.65 to 0.79), vertebral fractures (HR 0.68; 95% CI, 0.59 to 0.78), and hip fractures (HR 0.59; 95% CI, 0.50 to 0.70). Women who undertake a BP holiday from BP of ≥12 months duration for any reason after ≥3 years of BP use do not appear to be at greater risk of osteoporosis-related fragility fracture, hip, or vertebral fractures compared to ongoing BP users. In our cohort, BP holiday remains a viable strategy for balancing the benefits and potential harms associated with long-term BP use. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Annette L Adams
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John L Adams
- Kaiser Permanente Center for Effectiveness & Safety Research, Pasadena, CA, USA
| | - Marsha A Raebel
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Beth T Tang
- Kaiser Permanente Center for Effectiveness & Safety Research, Pasadena, CA, USA
| | - Jennifer L Kuntz
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Vinutha Vijayadeva
- The Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente Center for Effectiveness & Safety Research, Pasadena, CA, USA
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276
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Lundgren C, Lindman H, Rolander B, Ekholm M. Good adherence to adjuvant endocrine therapy in early breast cancer - a population-based study based on the Swedish Prescribed Drug Register. Acta Oncol 2018; 57:935-940. [PMID: 29493327 DOI: 10.1080/0284186x.2018.1442932] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Adjuvant endocrine therapy improves recurrence-free and overall survival in primary breast cancer. However, not all patients complete their planned treatment, mostly because of side-effects. The aim of this study was to examine the adherence to adjuvant endocrine therapy in a cohort of primary breast cancer patients in Region Jönköping County, Sweden, after 3 and 5 years. MATERIAL AND METHODS The Swedish Breast Cancer Register was used to identify patients diagnosed with hormone receptor positive breast cancer in Region Jönköping County between 2009 and 2012. Adherence was evaluated based on data from the Swedish Prescribed Drug Register, and Medication Possession Ratio (MPR), defined as the days' supply of medication during the period from the first dispensing till the last dispensing in the time period (3 and 5 years), divided by number of days. Adherence was defined as MPR ≥80%. Regression analyses were used to identify subgroups associated with adherence; age, type of endocrine treatment, additional adjuvant therapy, and hospital responsible for the follow-up (Eksjö, Jönköping, and Värnamo). RESULTS We identified 634 patients who were recommended adjuvant endocrine therapy and to be able to estimate adherence after 3 and 5 years, 488 patients were included in the analysis. After 3 years of treatment, 91.2% of the patients (95% confidence interval (CI) 88.7-93.6; n = 445), were found to be adherent. The corresponding figure for the 271 patients who had completed 5 years of treatment was 91.5% (95% CI 88.2-94.8; n = 248). No subgroups (age, endocrine therapy, radio/chemotherapy, or hospital) were significantly associated with adherence in the multiple logistic regression analysis. DISCUSSION This study shows substantially higher adherence to adjuvant endocrine therapy than previously reported. Reasons for this could be differences in routines for therapy information and follow-up, but this needs to be further investigated.
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Affiliation(s)
- Christine Lundgren
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Henrik Lindman
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Bo Rolander
- Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Maria Ekholm
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
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277
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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Glycemic control in type 2 diabetes: from medication nonadherence to residual vascular risk. Endocrine 2018; 61:23-27. [PMID: 29322300 DOI: 10.1007/s12020-017-1517-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 01/07/2023]
Abstract
Despite the availability of many new treatment options for type 2 diabetes, the proportion of patients achieving the HbA1c target < 7.0% remains around 50%. We put forward the hypothesis that the unchanged HbA1c results, observed in the last decade in type 2 diabetes patients, are also a consequence of medication nonadherence and clinical inertia. Poor medication-taking behavior is usually defined as medication nonadherence and is responsible for uncontrolled hemoglobin A1c level in 23% of cases. Medication nonadherence may also affect clinical outcomes, as diabetic patients with good adherence (≥80%) had a significant 10% lower rate of hospitalization events and a significant 28% lower rate of all-cause mortality when compared with patients with poor adherence (<80%). Residual vascular risk may be defined as the risk of macrovascular (major cardiovascular events) and microvascular (retinopathy, nephropathy, neuropathy) complications that remains after intensive and successful glycemic control in type 2 diabetes. For major cardiovascular events, risk reduction following intensive glycemic control is 9% and, therefore, residual vascular risk is 91%. For microvascular complications, as nephropathy, residual vascular risk is as high as 80%. Residual vascular risk remains high in type 2 diabetes despite intensive glycemic control. Medication nonadherence by the diabetic patient and clinical inertia by the clinician may have contributed to the high level of residual vascular risk (both macro and microvascular) of type 2 diabetic patients.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy.
| | - Maria Ida Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
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278
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Kim S, Kim H, Kim E, Han S, Rane PP, Fox KM, Zhao Z, Qian Y, Suh HS. Utilization Patterns of Lipid-lowering Therapies in Patients With Atherosclerotic Cardiovascular Disease or Diabetes: A Population-based Study in South Korea. Clin Ther 2018; 40:940-951.e7. [PMID: 29735297 DOI: 10.1016/j.clinthera.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE We aimed to study the utilization patterns of lipid-lowering treatment (LLT), including treatment modification, adherence, and possible statin intolerance, in patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes using national claims data in South Korea. METHODS A retrospective cohort study was conducted using data from the Korean Health Insurance Review & Assessment Service claims database. Patients aged ≥18 years with >1 outpatient pharmacy claim for a statin and/or ezetimibe dated January 1, 2012, to December 31, 2014, were identified and categorized into the following cohorts: patients with ASCVD, and patients with diabetes mellitus without ASCVD. LLT modification, adherence to index LLT, and possible statin intolerance were explored during the 12 months after the date of first prescription for a statin and/or ezetimibe. FINDINGS Among 1,399,872 patients who met the eligibility criteria, 807,547 (57.7%) were patients with ASCVD and 592,325 (42.3%) were patients with diabetes without ASCVD. About half of the patients had no modification in their index treatment (46.2% in the ASCVD cohort and 48.9% in the diabetes cohort), and the most common modification was permanent discontinuation (19.6% in the ASCVD cohort and 21.4% in the diabetes cohort). The mean medication possession ratios were 0.77 in the ASCVD cohort and 0.73 in the diabetes cohort and showed a decreasing trend during the 12-month follow-up period. Among patients who initiated a statin and/or ezetimibe, possible statin intolerance was observed in 53,921 patients (6.7%) in the ASCVD cohort and 42,172 patients (7.1%) in the diabetes cohort. IMPLICATIONS In South Korea, a high rate of permanent discontinuation of statin therapy in patients with ASCVD or diabetes places these patients at high risk for cardiovascular events in the future. A decreasing trend of adherence to LLT implies that more intensive education and management are required to improve therapeutic effect and reduce the risk for ASCVD. The high rate of possible statin intolerance highlights an unmet need in the prevention and management of ASCVD in South Korea.
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Affiliation(s)
- Siin Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hyungtae Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Eunju Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Sola Han
- College of Pharmacy, Pusan National University, Busan, South Korea
| | | | - Kathleen M Fox
- Strategic Healthcare Solutions, LLC, Aiken, South Carolina
| | | | - Yi Qian
- Amgen, Inc, Thousand Oaks, California
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, Busan, South Korea.
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279
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Gandapur Y, Kianoush S, Kelli HM, Misra S, Urrea B, Blaha MJ, Graham G, Marvel FA, Martin SS. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 2:237-244. [PMID: 29474713 DOI: 10.1093/ehjqcco/qcw018] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care.
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Affiliation(s)
- Yousuf Gandapur
- Department of Internal Medicine, Good Samaritan/Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA
| | - Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Satish Misra
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno Urrea
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garth Graham
- Aetna Foundation, Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Francoise A Marvel
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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280
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Exploring factors associated with patients' adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom. J Hypertens 2018; 35:1881-1890. [PMID: 28441185 DOI: 10.1097/hjh.0000000000001382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To explore factors associated with adherence to antihypertensive drugs overall (therapy adherence) and to particular classes (class adherence) in hypertensive patients. METHODS The current retrospective cohort study included adults with primary hypertension identified in the UK Clinical Practice Research Datalink from April 2006 to March 2013. Individuals were followed from the date of first-ever antihypertensive drug class (class adherence) prescribed and from the date of the first-ever antihypertensive drug (therapy adherence) issued to the earliest of study end, patient leaving the database, or death. Prescribing episodes (time from a drug class being first prescribed to the end of follow-up time) of six antihypertensive drug classes were recorded. Proportion of days covered (PDC) was used to estimate therapeutic adherence for a patient's antihypertensive drugs therapy during follow-up period and class adherence of a specific antihypertensive class in each episode, respectively. Generalized linear modelling was used to examine factors associated with PDC. RESULTS Median therapy and class PDC were 93.9 and 98.3% in the 176 835 patients and 371 605 prescribing episodes; 20 and 38.4% of the patients and episodes had PDC less than 80%, respectively. Higher therapy and class PDC was associated with increasing age, using renin angiotensin drugs, and being preexisting patient and user of antihypertensive drugs. Higher deprivation, multiple comorbidities, and switching of antihypertensive drugs were associated with lower PDC. CONCLUSION Several patient factors were confirmed as determinant of adherence to antihypertensive drug classes and therapy; hence, they can assist in identifying patients at risks of nonadherence, thus targeting them for adherence improving interventions.
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281
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McGovern A, Hinton W, Calderara S, Munro N, Whyte M, de Lusignan S. A Class Comparison of Medication Persistence in People with Type 2 Diabetes: A Retrospective Observational Study. Diabetes Ther 2018; 9:229-242. [PMID: 29302934 PMCID: PMC5801247 DOI: 10.1007/s13300-017-0361-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Longer medication persistence in type 2 diabetes (T2D) is associated with improved glycaemic control. It is not clear which oral therapies have the best persistence. The objective of this study was to compare medication persistence across different oral therapies in people with T2D. METHODS We performed a retrospective cohort analysis using a primary-care-based population, the Royal College of General Practitioners Research and Surveillance Centre cohort. We identified new prescriptions for oral diabetes medication in people with type 2 diabetes between January 1, 2004 and July 31, 2015. We compared median persistence across each class. We also compared non-persistence (defined as a prescription gap of ≥ 90 days) between classes, adjusting for confounders, using Cox regression. Confounders included: age, gender, ethnicity, socioeconomic status, alcohol use, smoking status, glycaemic control, diabetes duration, diabetes complications, comorbidities, and number of previous and concurrent diabetes medications. RESULTS We identified 60,327 adults with T2D. The majority 42,810 (70.9%) of those had one or more oral medications prescribed; we measured persistence in those patients (who were prescribed 55,728 oral medications in total). Metformin had the longest median persistence (3.04 years; 95% CI 2.94-3.12). The adjusted hazard ratios for non-persistence compared with metformin were: sulfonylureas HR 1.20 (1.16-1.24), DPP-4 inhibitors HR 1.43 (1.38-1.49), thiazolidinediones HR 1.71 (95% CI 1.64-1.77), SGLT2 inhibitors HR 1.04 (0.93-1.17), meglitinides HR 2.25 (1.97-2.58), and alpha-glucosidase inhibitors HR 2.45 (1.98-3.02). The analysis of SGLT2 inhibitors was limited by the short duration of follow-up for this new class. Other factors associated with reduced medication persistence were female gender, younger age, and non-white ethnicity. CONCLUSIONS Persistence is strongly influenced by medication class and should be considered when initiating treatments.
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Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK.
| | - William Hinton
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | | | - Neil Munro
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
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282
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Kim JJ, Hill HL, Groce JB, Granfortuna JM, Makhlouf TK. Pharmacy Student Monitoring of Direct Oral Anticoagulants. J Pharm Pract 2018; 31:462-468. [PMID: 29366379 DOI: 10.1177/0897190017752713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Best practice recommendations are lacking. Thus far, literature has described pharmacist-led DOAC monitoring. OBJECTIVE The purpose of this study is to describe a DOAC monitoring program involving pharmacy students. METHODS This was an observational analysis of a quality improvement initiative. A clinical pharmacist preceptor identified clinic patients taking DOACs by running a report using the electronic medical record. Pharmacy students conducted chart reviews, called pharmacies for 6-month refill histories, and interviewed and educated patients. Findings were communicated to the care team and interventions were performed as applicable with the preceptor. RESULTS Of 90 patients included, the mean age was 63 years, 54% were female, and 65.6% were black or African American. Rivaroxaban and apixaban were used most commonly. Sixty-two percent of DOACs were prescribed for atrial fibrillation/flutter, while 32.2% for venous thromboembolism. The mean MPR was 77.1%, with 27.7% of patients having an MPR ≤60%. Of the 136 student-led interventions, 25.2% involved medication access, 24.4% adherence education, 20.7% processing refills, 14.8% laboratory monitoring recommendations, 8.9% switching or recommending switching to another anticoagulant, and 4.4% stopping a nonsteroidal anti-inflammatory drug or aspirin. CONCLUSION Pharmacy students can help to ensure medication safety and effective use of DOACs.
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Affiliation(s)
- Jennifer J Kim
- 1 Greensboro Area Health Education Center, Greensboro, NC, USA.,2 Cone Health, Greensboro, NC, USA.,3 University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Hailey L Hill
- 3 University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - James B Groce
- 2 Cone Health, Greensboro, NC, USA.,4 Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.,5 UNC School of Medicine, Chapel Hill, NC, USA
| | - James M Granfortuna
- 2 Cone Health, Greensboro, NC, USA.,5 UNC School of Medicine, Chapel Hill, NC, USA
| | - Tanya K Makhlouf
- 3 University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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283
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Trevisan DD, São-João TM, Cornélio ME, Jannuzzi FF, Rodrigues RCM, Lima MHM. A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol. Contemp Nurse 2018; 53:658-668. [PMID: 29281941 DOI: 10.1080/10376178.2017.1421862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control. AIM To describe an experimental study protocol that aims at implementing and evaluating the effect of the "action planning and coping planning" interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services. DESIGN A randomized controlled trial. METHODS Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the "action planning" and "coping planning" intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit. CONCLUSIONS It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.
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Affiliation(s)
| | - Thaís M São-João
- a School of Nursing , University of Campinas , Campinas , Brazil
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284
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multi-disciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/content/clinical-practice-recommendations.
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285
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Bartlett LE, Pratt NL, Roughead EE. Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts. Patient Prefer Adherence 2018; 12:835-843. [PMID: 29805251 PMCID: PMC5960256 DOI: 10.2147/ppa.s150142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Many studies of persistence involving fixed dose combinations (FDCs) of cardiovascular medicines have not adequately accounted for a user's prior experience with similar medicines. The aim of this research was to assess the effect of prior medicine experience on persistence to combination therapy. PATIENTS AND METHODS Two retrospective cohort studies were conducted in the complete Pharmaceutical Benefits Scheme prescription claims dataset. Initiation and cessation rates were determined for combinations of: ezetimibe/statin; and amlodipine/statin. Initiators to combinations of these medicines between April and September 2013 were classified according to prescriptions dispensed in the prior 12 months as either: experienced to statin or calcium channel blocker (CCB); or naïve to both classes of medicines. Cohorts were stratified according to formulation initiated: FDC or separate pill combinations (SPC). Cessation of therapy over 12 months was determined using Kaplan-Meier survival analysis. Risk of cessation, adjusted for differences in patient characteristics was assessed using Cox proportional hazard models. RESULTS There were 12,169 people who initiated combinations of ezetimibe/statin; and 26,848 initiated combinations of amlodipine/statin. A significant proportion of each cohort were naïve initiators: ezetimibe/statin cohort, 1,964 (16.1%) of whom 81.9% initiated a FDC; and amlodipine/statin cohort, 5,022 (18.7%) of whom 55.4% initiated a FDC. Naïve initiators had a significantly higher risk of ceasing therapy than experienced initiators regardless of formulation initiated: ezetimibe/statin cohort, naïve FDC versus experienced FDC HR=3.0 (95% CI 2.8, 3.3) and naïve SPC versus experienced SPC HR=4.4 (95% CI 3.8, 5.2); and amlodipine/statin cohort naïve FDC versus experienced FDC HR=2.0 (95% CI 1.8, 2.2) and naïve SPC versus experienced SPC HR=1.5 (95% CI 1.4, 1.6). CONCLUSION Prescribers are initiating people to combinations of two cardiovascular medicines without prior experience to at least one medicine in the combination. This is associated with a higher risk of ceasing therapy than when combination therapy is initiated following experience with one component medicine. The use of FDC products does not overcome this risk.
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Affiliation(s)
- Louise E Bartlett
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
- Correspondence: Louise E Bartlett, Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, 101 Currie St, Adelaide, 5001, SA, Australia, Tel +61 408 244 776, Email
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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286
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Using Individual Experiences With Experimental Medications to Predict Medication-Taking Behavior Postauthorization: A DIA Study Endpoints Workstream. Ther Innov Regul Sci 2017; 51:404-415. [DOI: 10.1177/2168479017701979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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287
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Abstract
BACKGROUND Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates-extracted by comparing electronic health record prescriptions and pharmacy claims fills-represent a novel measure of medication adherence and may improve the performance of risk adjustment models. OBJECTIVE We evaluated the impact of prescription fill rates on claims-based risk adjustment models in predicting both concurrent and prospective costs and utilization. METHODS We conducted a retrospective cohort study of 43,097 primary care patients from HealthPartners network between 2011 and 2012. Diagnosis and/or pharmacy claims of 2011 were used to build 3 base models using the Johns Hopkins ACG system, in addition to demographics. Model performances were compared before and after adding 3 types of prescription fill rates: primary 0-7 days, primary 0-30 days, and overall. Overall fill rates utilized all ordered prescriptions from electronic health record while primary fill rates excluded refill orders. RESULTS The overall, primary 0-7, and 0-30 days fill rates were 72.30%, 59.82%, and 67.33%. The fill rates were similar between sexes but varied across different medication classifications, whereas the youngest had the highest rate. Adding fill rates modestly improved the performance of all models in explaining medical costs (improving concurrent R by 1.15% to 2.07%), followed by total costs (0.58% to 1.43%), and pharmacy costs (0.07% to 0.65%). The impact was greater for concurrent costs compared with prospective costs. Base models without diagnosis information showed the highest improvement using prescription fill rates. CONCLUSIONS Prescription fill rates can modestly enhance claims-based risk prediction models; however, population-level improvements in predicting utilization are limited.
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288
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Guedes JBR, Guerra MR, Alvim MM, Leite ICG. Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20:636-649. [DOI: 10.1590/1980-5497201700040007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/06/2017] [Indexed: 08/26/2023] Open
Abstract
RESUMO: Introdução: A hormonioterapia no câncer de mama é fundamental para a transição do tratamento ativo aos cuidados de sobrevivência, pois melhora significativamente os resultados de sobrevida em longo prazo, além de propiciar melhor qualidade de vida e reduzir os custos de hospitalização. Porém, para atingir resultados desejáveis, são importantes a adesão e a persistência no tratamento recomendado. Metodologia: Estudo de coorte retrospectivo com 182 mulheres em tratamento hormonal identificadas em unidade oncológica de alta complexidade da Região Sudeste do Brasil e acompanhadas até 2014. Foram realizadas análise bivariada, para investigar os fatores associados à adesão, e regressão multivariada de Cox, para identificar variáveis associadas à descontinuidade do tratamento ao longo do tempo. Resultados: A adesão geral foi de 85,2% e a persistência, de 45,4% após 5 anos. Não foi encontrada associação entre as variáveis independentes estudadas e a adesão. Mulheres com estadiamento avançado (hazard ratio - HR = 2,24; intervalo de confiança de 95% - IC95% 1,45 - 3,45), que não realizaram cirurgia (HR = 3,46; IC95% 2,00 - 5,97) e com 3 ou mais internações hospitalares (HR = 6,06; IC95% 2,53 - 14,54) exibiram maior risco de descontinuidade. Discussão: As variáveis associadas à persistência refletem a relação entre a maior gravidade da doença e a interrupção do tratamento hormonal adjuvante. Conclusão: Apesar da alta adesão, observa-se aumento progressivo do número de pacientes que não persistem no tratamento, devido a características relacionadas à gravidade da doença, contribuindo para uma resposta terapêutica inadequada.
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289
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Maggioni AP, Calabria S, Rossi E, Martini N. Use of lipid lowering drugs in patients at very high risk of cardiovascular events: An analysis on nearly 3,000,000 Italian subjects of the ARNO Observatory. Int J Cardiol 2017; 246:62-67. [DOI: 10.1016/j.ijcard.2017.02.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/21/2017] [Indexed: 11/15/2022]
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290
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Gellad WF, Thorpe CT, Steiner JF, Voils CI. The myths of medication adherence. Pharmacoepidemiol Drug Saf 2017; 26:1437-1441. [PMID: 28994158 DOI: 10.1002/pds.4334] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Walid F Gellad
- Division of General Medicine and Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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291
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Krueger K, Griese-Mammen N, Schubert I, Kieble M, Botermann L, Laufs U, Kloft C, Schulz M. In search of a standard when analyzing medication adherence in patients with heart failure using claims data: a systematic review. Heart Fail Rev 2017; 23:63-71. [DOI: 10.1007/s10741-017-9656-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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292
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Hui RL, Adams AL, Niu F, Ettinger B, Yi DK, Chandra M, Lo JC. Predicting Adherence and Persistence with Oral Bisphosphonate Therapy in an Integrated Health Care Delivery System. J Manag Care Spec Pharm 2017; 23:503-512. [PMID: 28345435 PMCID: PMC5641482 DOI: 10.18553/jmcp.2017.23.4.503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Examining drug exposure is essential to pharmacovigilance, especially for bisphosphonate (BP) therapy. OBJECTIVE To examine differences in 4 measures of oral BP exposure: treatment discontinuation, adherence, persistence, and nonpersistence. METHODS Among women aged ≥ 50 years who initiated oral BP therapy during 2002-2007 with at least 3 years of health plan membership follow-up, discontinuation was defined by evidence of no further treatment during the study observation period. Among those with at least 2 filled BP prescriptions during the study period, adherence was calculated for each year of follow-up using the (modified) proportion of days covered (mPDC) metric that allows for stockpiling of prescription/refills overlap ≤ 30 days supply. Persistence was quantified by treatment duration, allowing a gap of up to 60 days between prescription/refill days covered. Nonpersistence was quantified by the periods without drugs outside this allowable gap. Multivariable logistic regression was used to compare age and race groups and the relationships of early adherence (adherence during the first year) with subsequent adherence. RESULTS Among 48,390 women initiating oral BP therapy and followed for 3 years, 26.7% discontinued in year 1, and 14.7% of the remaining 35,456 women discontinued in year 2. Discontinuation rates were slightly higher (29.4%, P < 0.001) for women aged ≥ 75 years and somewhat lower (21.1%, P < 0.001) for Asian women. During the first year, 60.4% of the women achieved an mPDC of ≥ 75%, with demographic differences in adherence similar to that seen for treatment discontinuation. Over the 3 years, the median mPDC levels for BP therapy were 86%, 84%, and 85% in years 1, 2, and 3, respectively, for those receiving treatment. Cumulative persistence was 2.3 years (median, IQR = 1.0-3.0) overall and slightly greater for Asian versus white women and lower for older women. There were 18,174 (42.9%) women with at least 1 period of nonpersistence during 3 years follow-up in excess of the 60-day allowable gap between prescription/refills (median cumulative nonpersistence = 0.65, IQR = 0.30-1.25 years). Women with mPDC ≥ 75% during the first year had a 12-fold and 6-fold increased odds of mPDC ≥ 75% during year 2 and year 3, respectively. CONCLUSIONS BP discontinuation rates are highest for women during the first year. Among those continuing treatment in subsequent years, adherence rates were relatively stable. Persistence and adherence varied slightly by age and was somewhat higher in Asians, contributing to differences in cumulative BP exposure. We also found evidence that optimal adherence in the first year was highly predictive of optimal adherence in the subsequent 1-2 years. Hence, subgroups of patients receiving oral BP drugs may require different levels of support and monitoring to maximize treatment benefit, especially based on early patterns of use. DISCLOSURES This study was supported by grants from the Kaiser Permanente Northern California Community Benefit Program and the National Institutes of Health, 1R01AG047230-01A1. The opinions expressed in this publication are solely the responsibility of the authors and do not represent the official views of Kaiser Permanente or the National Institutes of Health. Hui, Yi, and Chandra have received past research funding from Amgen not related to the current study. Adams has received research funding from Amgen, Merck, and Otsuka not related to the current study. Niu has received research funding from Bristol-Myers Squibb not related to the current study. Ettinger has received past legal fees in litigation involving Fosamax. Lo has received past research funding from Amgen and current research funding from Sanofi not related to the current study. The data from this study were presented at the Academy of Managed Care Pharmacy Annual Meeting; April 19-22, 2016; San Francisco, California. Study concept and design were contributed primarily by Hui and Lo, along with Adams, Niu, Yi, and Ettinger. Hui took the lead in data collection, along with Chandra, and data interpretation was performed by Niu, Yi, and Lo, along with the other authors. The manuscript was written by Hui, Adams, and Lo, along with Niu, Yi, and Ettinger, and revised by Ettinger, Hui, Lo, and Niu, along with the other authors.
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Affiliation(s)
- Rita L Hui
- 1 Pharmacy Outcomes Research Group, Kaiser Permanente California, Oakland
| | - Annette L Adams
- 3 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Fang Niu
- 4 Pharmacy Outcomes Research Group, Kaiser Permanente California, Downey
| | - Bruce Ettinger
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
| | - David K Yi
- 3 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Malini Chandra
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
| | - Joan C Lo
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
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293
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Flory J, Gerhard T, Stempniewicz N, Keating S, Rowan CG. Comparative adherence to diabetes drugs: An analysis of electronic health records and claims data. Diabetes Obes Metab 2017; 19:1184-1187. [PMID: 28266807 DOI: 10.1111/dom.12931] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
Non-adherence to medications is a major challenge in diabetes care. The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. We used a data source that linked electronic prescriptions with insurance claims to assess whether new electronic prescriptions for diabetes medications were followed by dispensing claims consistent with that prescription. After one year of follow-up, the daily medication possession probability (MPP) - a measure of overall adherence - at one year for sulfonylurea was 0.49 and for metformin was 0.46. Thiazolidinediones and basal insulin had a similar final daily MPP at 0.36 and 0.39, respectively, which was significantly lower than that for sulfonylurea or metformin (P < .05). GLP-1 receptor agonists and DPP-4 inhibitors were also comparable to one another at a final daily MPP of .30 and .21, respectively (P < .05 compared to any of the aforementioned drug classes). In summary, the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. Physicians should be aware of potentially significant challenges concerning adherence to newer agents.
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Affiliation(s)
- James Flory
- Department of Healthcare Policy and Research, Weill Cornell School of Medicine, New York, New York
| | - Tobias Gerhard
- Health Care Policy and Aging Research, Institute for Health, Piscataway, New Jersey
| | | | - Scott Keating
- Department of Healthcare Policy and Research, Weill Cornell School of Medicine, New York, New York
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294
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Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain. Br J Gen Pract 2017; 67:e614-e622. [PMID: 28760740 DOI: 10.3399/bjgp17x692129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. AIM To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. DESIGN AND SETTING A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. METHOD Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. RESULTS Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. CONCLUSION Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.
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295
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296
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Mislang AR, Wildes TM, Kanesvaran R, Baldini C, Holmes HM, Nightingale G, Coolbrandt A, Biganzoli L. Adherence to oral cancer therapy in older adults: The International Society of Geriatric Oncology (SIOG) taskforce recommendations. Cancer Treat Rev 2017; 57:58-66. [PMID: 28550714 DOI: 10.1016/j.ctrv.2017.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
Abstract
There is an increasing trend towards using oral systemic therapy in patients with cancer. Compared to parenteral therapy, oral cancer agents offer convenience, have similar efficacy, and are preferred by patients, consequently making its use appealing in older adults. However, adherence is required to ensure its efficacy and to avoid compromising treatment outcomes, especially when the treatment goal is curative, or in case of symptomatic/rapidly progressing disease, where dose-intensity is important. This opens a new challenge for clinicians, as optimizing patient adherence is challenging, particularly due to lack of consensus and scarcity of available clinical evidence. This manuscript aims to review the impact of age-related factors on adherence, summarize the evidence on adherence, recommend methods for selecting patients suitable for oral cancer agents, and advise monitoring interventions to promote adherence to treatment.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Capucine Baldini
- Medical Hospital Huriez, University Lille Nord de France, Lille, France
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Annemarie Coolbrandt
- Oncology Nursing Department, University Hospitals Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato 59100, Italy.
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297
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Karter AJ, Parker MM, Solomon MD, Lyles CR, Adams AS, Moffet HH, Reed ME. Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE). Health Serv Res 2017; 53:1227-1247. [PMID: 28474736 DOI: 10.1111/1475-6773.12700] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. DATA SOURCES/SETTING Electronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012. STUDY DESIGN Observational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence. DATA COLLECTION Adherence and OOP costs were based on pharmacy dispensing records and benefits. PRINCIPAL FINDINGS Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost ≥$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p < .0001). Higher OOP cost was also strongly associated with inadequate secondary adherence (≥20 percent of time without adequate medication). There was no clinically significant or consistent relationship between OOP costs and early nonpersistence (dispensed once, never refilled) or later stage nonpersistence (discontinued within 24 months). CONCLUSIONS Cost-sharing may deter clinically vulnerable patients from initiating essential medications, undermining adherence and risk factor control.
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Affiliation(s)
- Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,University of California San Francisco Medical School, San Francisco, CA
| | - Melissa M Parker
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA.,Department of Medicine, Stanford University, Stanford, CA
| | - Courtney R Lyles
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Howard H Moffet
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mary E Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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298
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Lima-Dellamora EDC, Osorio-de-Castro CGS, Madruga LGDSL, Azeredo TB. Use of pharmacy records to measure treatment adherence: a critical review of the literature. CAD SAUDE PUBLICA 2017; 33:e00136216. [PMID: 28444026 DOI: 10.1590/0102-311x00136216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/06/2017] [Indexed: 01/02/2023] Open
Abstract
The current frame of reference on adherence to pharmacotherapy includes a set of behaviors experienced by the user, with observation of the detailed and continuous history of the use of each dose of the medication. Indicators based on pharmacy records have been used to measure adherence. The current review aimed to identify and describe indicators based on pharmacy records and to discuss their adequacy and limitations for measuring adherence. An exploratory literature review was conducted in three databases using the terms "adherence", "pharmacy records/administrative data", and "measure" to compose the descriptors for the selection of 81 articles and the elaboration of a chart with the denomination, sources, methods for calculation, description, and interpretation of the operational and referential meaning of 14 indicators. Given the most recent taxonomy for adherence proposed in the literature, we concluded that the indicators can be useful for identifying patients with medication-seeking behavior-related problems and analysis of persistence. The distance between supply-related events and difficulties in treatment follow-up can influence an analysis based exclusively on the use of these indicators.
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299
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Simpson SH, Lin M, Eurich DT. Community Pharmacy-Based Inducement Programs Associated With Better Medication Adherence: A Cohort Study. Ann Pharmacother 2017; 51:630-639. [PMID: 28372491 DOI: 10.1177/1060028017703720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inducement programs can promote customer loyalty; however, the clinical effects of these programs are unknown. OBJECTIVE To examine relationships among inducement program use, medication adherence, and health outcomes. METHODS Alberta residents with ≥ 1 physician visit for diabetes or hypertension between April 2008 and March 2014 were eligible for this study and included if they were new statin users and alive at least 455 days after the first statin dispensation. Group assignment was based on whether all statin dispensations in the first year were obtained from pharmacies with or without inducement programs. Discontinuation was defined as no statin dispensations between 275 and 455 days after the first statin dispensation. Acute coronary syndrome (ACS) hospitalizations or deaths were identified between 456 days and 3 years after the first statin dispensation. Multivariable regression analyses were conducted to examine relationships among inducement program use, discontinuation, and ACS events. RESULTS Among the 159 998 new statin users, mean age was 60.2 (±13.7) years and 67 534 (42%) were women. Statin discontinuation occurred in 22 455 (28.9%) of 77 803 inducement group participants and 25 816 (31.4%) of 82 195 noninducement group participants (adjusted odds ratio = 0.88; 95% CI = 0.86-0.90). Risk of an ACS event was similar between groups (adjusted hazard ratio = 1.00; 95% CI 0.92-1.08); however, discontinuing statin therapy was associated with a higher risk of an ACS event (adjusted hazard ratio = 1.27; 95% CI = 1.16-1.39). CONCLUSIONS Inducement programs are associated with better adherence and not directly associated with risk of health outcomes.
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Affiliation(s)
| | - Mu Lin
- 1 University of Alberta, Edmonton, AB, Canada
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300
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Reed ME, Warton EM, Kim E, Solomon MD, Karter AJ. Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan. Health Aff (Millwood) 2017; 36:516-523. [DOI: 10.1377/hlthaff.2016.1316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mary E. Reed
- Mary E. Reed ( ) is a research scientist in the Division of Research at Kaiser Permanente, in Oakland, California
| | - E. Margaret Warton
- E. Margaret Warton is a consulting data analyst in the Division of Research at Kaiser Permanente
| | - Eileen Kim
- Eileen Kim is chief of outpatient quality in the East Bay service area at Kaiser Permanente
| | - Matthew D. Solomon
- Matthew D. Solomon is a physician researcher in the Department of Cardiology at Kaiser Permanente
| | - Andrew J. Karter
- Andrew J. Karter is a research scientist in the Division of Research at Kaiser Permanente
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