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Xu Y, Zheng X, Li Y, Ye X, Cheng H, Wang H, Lyu J. Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review. J Evid Based Med 2023; 16:342-375. [PMID: 37718729 DOI: 10.1111/jebm.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery. METHODS We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications. RESULTS Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality. CONCLUSION Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.
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Affiliation(s)
- Yixian Xu
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuanjie Li
- Planning & Discipline Construction Office, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinmiao Ye
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051981. [PMID: 36902770 PMCID: PMC10004070 DOI: 10.3390/jcm12051981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.
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AD M, JP P, A A, JP L, CA H. The influence of demographics and comorbidity on persistence with anti-seizure medication. Seizure 2022; 97:88-93. [DOI: 10.1016/j.seizure.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
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Grove LR, Gertner AK, Swietek KE, Lin CCC, Ray N, Malone TL, Rosen DL, Zarzar TR, Domino ME, Sheitman B, Steiner BD. Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening. J Gen Intern Med 2021; 36:970-977. [PMID: 33506397 PMCID: PMC8041990 DOI: 10.1007/s11606-020-06429-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking. OBJECTIVE To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening. DESIGN Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics. PARTICIPANTS People with SMI newly receiving primary care in North Carolina. INTERVENTIONS Enhanced primary care that includes features tailored for individuals with SMI. MAIN MEASURES Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit. KEY RESULTS Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening. CONCLUSIONS Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.
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Affiliation(s)
- Lexie R Grove
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.
| | - Alex K Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA
| | | | | | - Neepa Ray
- Center for Medication Optimization, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tyler L Malone
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA
| | - David L Rosen
- Institute for Global Health and Infectious Diseases, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Theodore R Zarzar
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brian Sheitman
- North Carolina Department of Public Safety-Prisons, Raleigh, USA
| | - Beat D Steiner
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Jang H, Im J, Park K. Adherence to Dietary Guidelines among Diabetes Patients: Comparison between Elderly and Non-Elderly Groups. Clin Nutr Res 2021; 10:14-23. [PMID: 33564649 PMCID: PMC7850814 DOI: 10.7762/cnr.2021.10.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to compare adherence to dietary guidelines between elderly and non-elderly individuals with type 2 diabetes mellitus (T2DM) in Korea. Data of 4,577 participants with T2DM were collected from the 1998-2015 Korea National Health and Nutrition Examination Surveys. The participants were classified into two groups based on age: non-elderly T2DM group comprising participants aged 30-64 years and elderly T2DM group comprising participants aged ≥ 65 years. Adherence to dietary guidelines was assessed using the Korean Diabetes Association-Korean Ministry of Health and Welfare (KDA-KMHW) index, comprising six components of dietary guidelines for T2DM patients. Multivariable generalized linear regression analysis was performed to analyze the KDA-KMHW index scores. The adherence levels to the individual components of the KDA-KMHW index were mostly lower in non-elderly group (p < 0.001) than elderly group, except for moderate carbohydrate consumption. The total KDA-KMHW index score was significantly lower in non-elderly T2DM group than in the elderly T2DM group (p < 0.001). The study results suggest the need for developing patient-specific education programs that focus on adherence to dietary guidelines, particularly for non-elderly patients, to adequately intervene with the difficulties experienced in T2DM dietary management.
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Affiliation(s)
- Haeun Jang
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Jihyun Im
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Kyong Park
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
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Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103742. [PMID: 32466267 PMCID: PMC7277774 DOI: 10.3390/ijerph17103742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes.
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Alves Peres H, Leira Pereira LR, Zangiacomine Martinez E, Viana CM, de Freitas MCF. Elucidating factors associated with non-adherence among Type 1 diabetes patients in primary care setting in Southeastern Brazil. Prim Care Diabetes 2020; 14:85-92. [PMID: 31262602 DOI: 10.1016/j.pcd.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/15/2022]
Abstract
AIMS To explore the factors associated with adherence and non-adherence to the pharmacological treatment of patients with T1DM in primary care setting southeast Brazil. METHODS We conducted a cross-sectional study with 158 patients attending in the primary health care in the city of Franca southeast Brazil and measure adherence to antidiabetic medication. Adherence was measure using Morisky-Green Test modified. RESULTS The majority of patients was adherence to antidiabetic medication (63.2%). More than one third of patients were non-adherent treated pharmacologically and comorbidities most prevalent were hypertension (63.8%), dyslipidemia (43.1%) and depression (32.8%). Depression were strongest predictor OR=2.8 (1.2-6.5) of non-adherence. CONCLUSION Depression is a factor associated with non-adherence to pharmacological treatment in patients with T1DM, and in clinical practice, screening for depression and intervention as well as pharmaceutical care may improve adherence to pharmacotherapy.
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Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Edson Zangiacomine Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss de Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Moreno Juste A, Menditto E, Orlando V, Monetti VM, Gimeno Miguel A, González Rubio F, Aza-Pascual-Salcedo MM, Cahir C, Prados Torres A, Riccardi G. Treatment Patterns of Diabetes in Italy: A Population-Based Study. Front Pharmacol 2019; 10:870. [PMID: 31447672 PMCID: PMC6691351 DOI: 10.3389/fphar.2019.00870] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The steady increase in type 2 diabetes prevalence and the availability of new antidiabetic drugs (AD) have risen the use of these drugs with a change in the patterns of specific drug utilization. The complexity of this treatment is due to successive treatment initiation, switching and addition in order to maintain glycaemic control. The aim of this study was to describe the utilization patterns of ADs at initiation, treatment addition, and switching profiles and to measure factors influencing persistence to therapy. Methods: Retrospective observational study. Data were retrieved from the Campania Regional Database for Medication Consumption. Population consisted of patients receiving at least one prescription of ADs between January 1 and December 31, 2016. We calculated time to treatment switching or add-on as median number of days and interquartile range (IQR). Persistence rates were estimated using the Kaplan–Meier method. We used Cox regression models to estimate the likelihood of non-persistence over 1 year of follow-up. Hazard ratios and 95% confidence intervals were calculated. Results: Of 14,679 patients, 86.9% started with monotherapy and 13.1% with combination therapy. Most common initial treatment was metformin in both monotherapy and combination therapy. First-line prescription of sulfonylurea was observed in 6.9% of patients aged 60–79 years and in 10.8% of patients aged ≥80 years. Patients starting with metformin showed fewer treatment modifications (10.4%) compared to patients initiating with sulfonylureas (35.2%). Newer ADs were utilized during treatment progression. Patients who initiated with sulfonylurea were approximately 70% more likely to discontinue treatment compared to those initiated on metformin. Oldest age group (≥80 years) was more likely to be non-persistent, and likelihood of non-persistence was highest in polymedicated patients. Patients changing therapy were more likely to be persistent. Conclusions: Our results show that treatment of T2D in Italy is consistent with clinical guidelines. Even if newer ADs were utilized during disease progression, they seem not to be preferred in patients with a higher comorbidity score, although these patients could benefit from this kind of treatment. Our study highlights patients’ characteristics that might help identify those who would benefit from counselling from their health-care practitioner on better AD usage.
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Affiliation(s)
- Aida Moreno Juste
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII. Miguel Servet University Hospital, Zaragoza, Spain.,Aragon Health Service (SALUD), Department III of Zaragoza, Zaragoza, Spain
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | | | - Antonio Gimeno Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII. Miguel Servet University Hospital, Zaragoza, Spain
| | - Francisca González Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII. Miguel Servet University Hospital, Zaragoza, Spain.,Aragon Health Service (SALUD), Department III of Zaragoza, Zaragoza, Spain
| | - María Mercedes Aza-Pascual-Salcedo
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII. Miguel Servet University Hospital, Zaragoza, Spain.,Aragon Health Service (SALUD), Department III of Zaragoza, Zaragoza, Spain
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alexandra Prados Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII. Miguel Servet University Hospital, Zaragoza, Spain
| | - Gabriele Riccardi
- Diabetes, Nutrition and Metabolism research group, Department of clinical Medicine and Surgery, Frederico II Universityn, Naples, Italy
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A novel superior medication-based chronic disease score predicted all-cause mortality in independent geriatric cohorts. J Clin Epidemiol 2019; 105:112-124. [DOI: 10.1016/j.jclinepi.2018.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/24/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022]
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Aga F, Dunbar SB, Kebede T, Gary RA. The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review. Diabetes Metab Syndr Obes 2019; 12:333-356. [PMID: 31114271 PMCID: PMC6497834 DOI: 10.2147/dmso.s186758] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/11/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals. Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D. Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS). Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors. Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.
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Affiliation(s)
- Fekadu Aga
- Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Fekadu AgaDepartment of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, P.O. Box 9083, Addis AbabaTel +125 191 103 3684Email
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA30322, USA
| | - Tedla Kebede
- Tikur Anbessa Specialized Hospital, Diabetes & Endcrinology Unit, Department of Internal Medicine School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA30322, USA
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Moreno Juste A, Gimeno Miguel A, Poblador Plou B, González Rubio F, Aza Pascual-Salcedo MM, Menditto E, Prados Torres A. Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort. Med Clin (Barc) 2018; 153:1-5. [PMID: 30503066 DOI: 10.1016/j.medcli.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Sub-optimal adherence to treatment in the general population has been highlighted in several studies, especially in the elderly and/or chronic patients. This study aims to describe the adherence to treatment of diabetes mellitus, dyslipidaemia and hypertension, and to identify the factors that influence adherence. MATERIAL AND METHOD Retrospective, cross-sectional observational study on 16,208 patients aged ≥65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic, a lipid-lowering or an antihypertensive medication in 2010. Adherence was measured by calculating the medication possession ratio during one year, considering those cases with medication possession ratio ≥80% to be adherent. We performed a descriptive study, and a logistic regression model was used to identify the predictors of low adherence. RESULTS Adherence to antidiabetics, antihypertensive and lipid-lowering drugs was 72.4%, 50.7% and 44.3%, respectively. An increase in adherence of 3-8% was observed for each additional chronic disease suffered by the patient. The presence of mental illness did not affect adherence, and sex, age and number of prescribed drugs did not present consistent effects. CONCLUSION The results obtained show a sub-optimal adherence to treatment for the 3chronic diseases studied. Adherence increased with the number of chronic diseases, while sex, age and number of drugs did not show a consistent effect. It is necessary to investigate if there are other factors that may influence therapeutic adherence, since improving adherence may have a greater impact on health than any progress in therapies.
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Affiliation(s)
- Aida Moreno Juste
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España.
| | - Antonio Gimeno Miguel
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Beatriz Poblador Plou
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Francisca González Rubio
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España; Grupo de Trabajo de Utilización de Fármacos de la semFYC, España
| | - María Mercedes Aza Pascual-Salcedo
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España
| | - Enrica Menditto
- CIRFF, Centro de Farmacoeconomía, Universidad de Nápoles Federico II, Nápoles, Italia
| | - Alexandra Prados Torres
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
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12
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Menditto E, Cahir C, Aza-Pascual-Salcedo M, Bruzzese D, Poblador-Plou B, Malo S, Costa E, González-Rubio F, Gimeno-Miguel A, Orlando V, Kardas P, Prados-Torres A. Adherence to chronic medication in older populations: application of a common protocol among three European cohorts. Patient Prefer Adherence 2018; 12:1975-1987. [PMID: 30323567 PMCID: PMC6179242 DOI: 10.2147/ppa.s164819] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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 The purpose of this study was to evaluate and compare medication adherence to chronic therapies in older populations across different regions in Europe. METHODS This explorative study applied a harmonized method of data extraction and analysis from pharmacy claims databases of three European countries to compare medication adherence at a cross-country level. Data were obtained for the period between January 1, 2010, and December 31, 2011. Patients (aged ≥65 years) who newly initiated to oral antidiabetics, antihyperlipidemics, or antiosteoporotics were identified and followed for over a 12-month period. Main outcome measures were medication adherence (medication possession ratio, [MPR]; implementation) and persistence on index treatment. All country-specific data sets were prepared by employing a common data input model. Outcome measures were calculated for each country and pooled using random effect models. RESULTS In total, 39,186 new users were analyzed. In pooled data from the three countries, suboptimal implementation (MPR <80%) was 52.45% (95% CI: 33.43-70.79) for antihy-perlipidemics, 61.35% (95% CI: 52.83-69.22) for antiosteoporotics, and 30.33% (95% CI: 25.53-35.60) for oral antidiabetics. Similarly, rates of non-persistence (discontinuation) were 55.63% (95% CI: 35.24-74.29) for antihyperlipidemics, 60.24% (95% CI: 45.35-73.46) for antiosteoporotics, and 46.80% (95% CI: 36.40-57.4) for oral antidiabetics. CONCLUSION Medication adherence was suboptimal with >50% of older people non-adherent to antihyperlipidemics and antiosteoporotics in the three European cohorts. However, the degree of variability in adherence rates among the three countries was high. A harmonized method of data extraction and analysis across health-related database in Europe is useful to compare medication-taking behavior at a cross-country level.
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Affiliation(s)
- Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy,
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mercedes Aza-Pascual-Salcedo
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Madrid, Spain
- Aragon Health Service (SALUD), Aragon, Spain
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | | | - Sara Malo
- University of Zaragoza, Zaragoza, Spain
| | - Elisio Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy, Porto4ageing Reference Site, University of Porto, Porto, Portugal
| | - Francisca González-Rubio
- Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Madrid, Spain
- Aragon Health Service (SALUD), Aragon, Spain
- University of Zaragoza, Zaragoza, Spain
| | | | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy,
| | - Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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Ballegaard C, Højgaard P, Dreyer L, Cordtz R, Jørgensen TS, Skougaard M, Tarp S, Kristensen LE. Impact of Comorbidities on Tumor Necrosis Factor Inhibitor Therapy in Psoriatic Arthritis: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:592-599. [DOI: 10.1002/acr.23333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Christine Ballegaard
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Pil Højgaard
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Lene Dreyer
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital, Hellerup; and DANBIO Registry and Rigshospitalet; Glostrup Denmark
| | - René Cordtz
- The Parker Institute and Copenhagen University Hospital; Bispebjerg and Frederiksberg Hospital; and Gentofte Hospital; Hellerup Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Marie Skougaard
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Simon Tarp
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
| | - Lars Erik Kristensen
- The Parker Institute and Copenhagen University Hospital and Bispebjerg and Frederiksberg Hospital; Hellerup Denmark
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. Factors associated with antidiabetic medication non-adherence in patients with incident comorbid depression. J Diabetes Complications 2017; 31:1200-1206. [PMID: 28325698 DOI: 10.1016/j.jdiacomp.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify factors associated with antidiabetic drug (AD) non-adherence among patients with type 2 diabetes and depression. STUDY DESIGN AND SETTINGS We conducted a population-based retrospective cohort study among new AD users with a diagnosis of depression following AD initiation. We used public health insurance data from Quebec. The dependent variable was non-adherence (i.e., <90% of days covered by ≥1AD) in the year after a depression diagnosis. Different sociodemographic, clinical and medication-related variables were assessed as potential factors of non-adherence to AD treatment. We performed univariate and multivariate logistic regressions. RESULTS We identified 3106 new users of ADs with a diagnosis of depression between 2000 and 2006. Of these individuals, 52% were considered non-adherent to their ADs. Baseline non-adherence, younger age, the addition of another AD to the initial treatment, <4 drug claims, visits with several different physicians, high socioeconomic status, and a small number of diabetes complications were associated with AD non-adherence. CONCLUSIONS The factors identified in the present study may help clinicians recognize patients with type 2 diabetes and incident depression at increased risk for non-adherence. In these patients, close follow-up and targeted interventions could help improve adherence to AD treatment, improve glycemic control and reduce complications.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada.
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15
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Multidimensional factors affecting medication adherence among community-dwelling older adults: a structural-equation-modeling approach. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Grimes RT, Bennett K, Tilson L, Usher C, Smith SM, Henman MC. Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients. Br J Clin Pharmacol 2016; 79:1000-9. [PMID: 25521800 DOI: 10.1111/bcp.12573] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim was to describe the utilization of antidiabetic agents, in terms of persistence and regimen change, in the management of a cohort of newly treated type 2 diabetes patients and to investigate associated socio-demographic and treatment factors. METHODS A population-based retrospective cohort study was conducted using the national pharmacy claims database in Ireland. Subjects were analyzed for persistence and regimen change. Cox proportional hazards regression examined associations of socio-demographic and treatment factors on treatment patterns. Hazard ratios (HR) and 95% CIs are presented. RESULTS A total of 20947 subjects were identified in the study over a 2 year period. Most were initiated on metformin (76%) or sulphonylureas (22%) and 77% were persistent with therapy 12 months after initiation. The likelihood of non-persistence was significantly lower in the youngest (40-49 years) age groups (reference 60-69 years) (HR 1.62, 95% CI 1.42, 1.84) and those on sulphonylureas (HR 1.49, 95% CI 1.36, 1.64). The likelihood of receiving a regimen change was significantly lower in the older (80+ years) age groups (HR 0.63, 95% CI 0.56, 0.71), females (HR 0.91, 95% CI 0.86, 0.95), and those with pre-existing CVD (1 vs. 0 CVD medicines) (HR 0.82, 95% CI 0.74, 0.90), and higher in those on sulphonylureas (HR 1.83, 95% CI 1.73, 1.94). CONCLUSIONS Type of treatment, pre-existing CVD and demographic factors are shown to be associated with the observed treatment patterns. Guideline recommended agents were widely used on treatment initiation though a substantial minority were not initiated on the recommended first line agent. Use of guideline recommended agents was not as evident during treatment progression. Further optimization of initial and subsequent antidiabetic agent prescribing may be possible.
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Affiliation(s)
- Ronan T Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Lesley Tilson
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Cara Usher
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Capoccia K, Odegard PS, Letassy N. Medication Adherence With Diabetes Medication: A Systematic Review of the Literature. DIABETES EDUCATOR 2015; 42:34-71. [PMID: 26637240 DOI: 10.1177/0145721715619038] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The primary purpose of this systematic review is to synthesize the evidence regarding risk factors associated with nonadherence to prescribed glucose-lowering agents, the impact of nonadherence on glycemic control and the economics of diabetes care, and the interventions designed to improve adherence. METHODS Medline, EMBASE, the Cochrane Collaborative, BIOSIS, and the Health and Psychosocial Instruments databases were searched for studies of medication adherence for the period from May 2007 to December 2014. Inclusion criteria were study design and primary outcome measuring or characterizing adherence. Published evidence was graded according to the American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines. RESULTS One hundred ninety-six published articles were reviewed; 98 met inclusion criteria. Factors including age, race, health beliefs, medication cost, co-pays, Medicare Part D coverage gap, insulin use, health literacy, primary nonadherence, and early nonpersistence significantly affect adherence. Higher adherence was associated with improved glycemic control, fewer emergency department visits, decreased hospitalizations, and lower medical costs. Adherence was lower when medications were not tolerated or were taken more than twice daily, with concomitant depression, and with skepticism about the importance of medication. Intervention trials show the use of phone interventions, integrative health coaching, case managers, pharmacists, education, and point-of-care testing improve adherence. CONCLUSION Medication adherence remains an important consideration in diabetes care. Health professionals working with individuals with diabetes (eg, diabetes educators) are in a key position to assess risks for nonadherence, to develop strategies to facilitate medication taking, and to provide ongoing support and assessment of adherence at each visit.
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Affiliation(s)
- Kam Capoccia
- College of Pharmacy, Western New England University, Springfield, Massachusetts (Dr Capoccia)
| | - Peggy S Odegard
- School of Pharmacy, University of Washington, Seattle, Washington (Dr Odegard)
| | - Nancy Letassy
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Dr Letassy)
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Chang PY, Chien LN, Lin YF, Chiou HY, Chiu WT. Nonadherence of Oral Antihyperglycemic Medication Will Increase Risk of End-Stage Renal Disease. Medicine (Baltimore) 2015; 94:e2051. [PMID: 26632708 PMCID: PMC5058977 DOI: 10.1097/md.0000000000002051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Poor glycemic control is related to an increased risk of end-stage renal disease (ESRD). This study investigated the association between medication adherence and the risk of ESRD in patients with newly diagnosed diabetes mellitus.In this population-based cohort study, we used the Taiwan National Health Insurance Research Database (NHIRD) to identify 559,864 patients with newly diagnosed or treated diabetes mellitus who were ages from 20 to 85 years between 2001 and 2008. We identified 1695 patients with ESRD during the study period. The mean follow-up time of the patients with ESRD was 5.7 years. Time-dependent Cox proportional hazards regression was performed to estimate the hazard ratios for ESRD among the patients with newly diagnosed diabetes mellitus.After adjustment for various covariates, nonadherence to oral antihyperglycemic medication (OAM) was associated with a higher risk of ESRD compared with adherence to OAM (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.01-1.23). The effects of nonadherence to OAM on the risk of ESRD were significant for patients without hypertension, without gout, without chronic kidney disease, undergoing OAM polytherapy, and undergoing metformin polytherapy (HR [95% CIs], 1.18 [1.00-1.39], 1.13 [1.02-1.26], 1.17 [1.03-1.33], 1.22 [1.08-1.38], and 1.13 [1.02-1.25], respectively).In conclusion, nonadherence to OAM therapy is associated with ESRD. Adherence to medication therapy can prevent the progressive loss of renal function and ESRD for patients with diabetes.
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Affiliation(s)
- Po-Ya Chang
- From the School of Public Health (P-YC, H-YC), School of Health Care Administration (L-NC), Graduate Institute of Clinical Medicine (Y-FL), and Graduate Institute of Injury Prevention and Control (W-TC), Taipei Medical University, Taipei, Taiwan
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Simard P, Presse N, Roy L, Dorais M, White-Guay B, Räkel A, Perreault S. Persistence and adherence to oral antidiabetics: a population-based cohort study. Acta Diabetol 2015; 52:547-56. [PMID: 25524433 DOI: 10.1007/s00592-014-0692-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/27/2014] [Indexed: 01/12/2023]
Abstract
AIMS A population-based cohort study design was used to estimate persistence rate, re-initiation rate after discontinuation, and adherence level among incident users of oral antidiabetics (OADs), and to investigate predictors of non-persistence and non-adherence. METHODS Incident OAD users were identified using healthcare databases of residents covered by the public drug insurance plan of the Province of Quebec, Canada. Patients initiated OAD therapy between January 2000 and October 2009 and were aged 45-85 years at cohort entry. Persistence rate, re-initiation after discontinuation, and adherence level were assessed over 2 years. Predictors of non-persistence and non-adherence were analyzed using Cox and logistic regression models, respectively. RESULTS The cohort included 160,231 incident OAD users at entry. One year after OAD initiation, persistence rate was 51 % and adherence level 67 %. Among those deemed non-persistent, 80.6 % re-initiated OAD therapy within 12 months of discontinuation; a proportion increasing with primary persistence duration. The 1-year persistence rate varied according to OAD classes; being the highest for thiazolidinediones (62 %) and the lowest for alpha-glucosidase inhibitors (30 %). The likelihood for non-persistence was 39-54 % higher when drug copayments were required. Conversely, OAD discontinuation was least likely for patients with schizophrenia [hazard ratio 0.70 (95 % CI 0.67-0.73)], dyslipidemia [0.85 (0.84-0.87)], anticoagulation [0.86 (0.83-0.88)], hypertension [0.87 (0.85-0.88)], and ≥7 medications [0.90 (0.88-0.91)]. Predictors of non-adherence were similar. CONCLUSIONS Non-persistence and non-adherence to OAD therapy were common, although re-initiation rate was high. OAD classes, drug copayments, comorbidities and co-medications may help identifying those who were more likely to benefit from counseling.
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Affiliation(s)
- Patrice Simard
- Faculté de Pharmacie, Université de Montréal, PO Box 6128, Centre-Ville Station, Montreal, QC, H3C 3J7, Canada
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McGowan B, Bennett K, Silke C, Whelan B. Adherence and persistence to urate-lowering therapies in the Irish setting. Clin Rheumatol 2014; 35:715-21. [PMID: 25409858 DOI: 10.1007/s10067-014-2823-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 10/20/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Abstract
To identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.
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Affiliation(s)
- Bernie McGowan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.
| | - Kath Bennett
- The Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Carmel Silke
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bryan Whelan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.,The Department of Medicine, National University of Ireland, Galway, Ireland
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