1
|
Ruksakulpiwat S, Benjasirisan C, Ding K, Phianhasin L, Thorngthip S, Ajibade AD, Thampakkul J, Zhang AY, Voss JG. Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review. Patient Prefer Adherence 2023; 17:2161-2174. [PMID: 37667687 PMCID: PMC10475305 DOI: 10.2147/ppa.s420059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke. Objective To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH. Methods This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative. Results Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients. Conclusion Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.
Collapse
Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sutthinee Thorngthip
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anuoluwapo D Ajibade
- College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Jai Thampakkul
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
2
|
Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study. Drugs Real World Outcomes 2023; 10:23-29. [PMID: 36703097 PMCID: PMC9944347 DOI: 10.1007/s40801-023-00352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Poor medication adherence is prevalent among older people. To optimize therapeutic outcomes, it is crucial to understand the underlying causes and perceptions. OBJECTIVE We aimed to investigate the extent of self-reported medication adherence and associated factors among older people admitted to hospital. METHODS Individuals living at home aged ≥ 75 years with an emergency admission at a university hospital between September 2018 and September 2021 were included. Participants answered the Medication Adherence Report Scale (MARS-5) questionnaire upon admission regarding their prescribed long-term medications. Participants with a MARS-5 score of 23-25 were defined as adherent and with a score of 5-22 as nonadherent. A multivariable logistic regression analysis was performed to investigate possible factors independently associated with self-reported medication adherence. RESULTS A total of 261 individuals were included. The mean age was 84 years (standard deviation 5.7) and the mean MARS-5 score was 23.9 (standard deviation 1.8). Overall, 227 (87%) participants were classified as adherent to their prescribed treatment, while 34 (13%) participants were classified as nonadherent. Participants with cognitive impairment (odds ratio = 0.40, 95% confidence interval 0.18-0.90, p = 0.027) and depression (odds ratio = 0.29, 95% confidence interval 0.10-0.87, p = 0.028) had a lower odds of reporting adherence to their medications. CONCLUSIONS The majority of individuals aged ≥ 75 years who were recently hospitalized rated themselves as adherent to their prescribed medications according to MARS-5. Future studies would benefit from adding more possible explanatory factors and combining a self-reported assessment with a more objective measurement of medication adherence.
Collapse
|
3
|
Norberg H, Sjölander M, Glader EL, Gustafsson M. Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study. Eur J Clin Pharmacol 2022; 78:869-877. [PMID: 35156130 PMCID: PMC9005421 DOI: 10.1007/s00228-022-03284-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03284-4.
Collapse
Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden.
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umea, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
| |
Collapse
|
4
|
Dalli LL, Kim J, Thrift AG, Andrew NE, Sanfilippo FM, Lopez D, Grimley R, Lannin NA, Wong L, Lindley RI, Campbell BCV, Anderson CS, Cadilhac DA, Kilkenny MF. Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke. Neurology 2020; 96:e30-e41. [PMID: 33093227 DOI: 10.1212/wnl.0000000000011083] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. METHODS This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. RESULTS Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62-0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57-0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77-0.98) were all inversely associated with antihypertensive discontinuation. CONCLUSIONS Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
Collapse
Affiliation(s)
- Lachlan L Dalli
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Joosup Kim
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Amanda G Thrift
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Nadine E Andrew
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Frank M Sanfilippo
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Derrick Lopez
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Rohan Grimley
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Natasha A Lannin
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Lillian Wong
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Richard I Lindley
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Bruce C V Campbell
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Craig S Anderson
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Dominique A Cadilhac
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Monique F Kilkenny
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China.
| | | |
Collapse
|
5
|
Wawruch M, Wimmer G, Murin J, Paduchova M, Petrova M, Tesar T, Matalova P, Havelkova B, Trnka M, Aarnio E. Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status. Biomedicines 2020; 8:biomedicines8100378. [PMID: 32992971 PMCID: PMC7599852 DOI: 10.3390/biomedicines8100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients’ adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012–December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients’ persistence.
Collapse
Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia;
- Correspondence: (M.W.); (T.T.)
| | - Gejza Wimmer
- Institute of Measurement Science, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia;
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia;
| | | | - Miriam Petrova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia;
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, 832 32 Bratislava, Slovakia
- Correspondence: (M.W.); (T.T.)
| | - Petra Matalova
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic;
| | - Beata Havelkova
- General Health Insurance Company, 851 04 Bratislava, Slovakia;
| | - Michal Trnka
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia;
| | - Emma Aarnio
- Institute of Biomedicine, University of Turku, 20014 Turku, Finland;
- School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
| |
Collapse
|
6
|
Jang DE, Zuñiga JA. Factors associated with medication persistence among ischemic stroke patients: a systematic review. Neurol Res 2020; 42:537-546. [PMID: 32321382 DOI: 10.1080/01616412.2020.1754640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE An investigation of the prevalence of medication persistence and associated factors in order to inform effective strategies for improving medication persistence. METHODS A systematic review of the literature from 2010 to the present was performed, using the PRISMA protocol. Primary and empirical observational studies of adult ischemic stroke or transient ischemic attack patients were included. PubMed, CINAHL, Web of Science, Cochrane Library, and PsycInfo databases were searched using the key terms stroke, ischemic stroke, medication persistence, medication adherence, and patient compliance. RESULTS Of four hundred twenty-eight journal articles retrieved, a final 18 articles were included. Short-term medication persistence was 46.2-96.7%, and long-term medication persistence was 41.7-93.0%. Identified hospital-related factors for medication persistence were stroke unit care, in-hospital medical complications, and early follow-up visit. Demographic factors for medication persistence were older age, and high/adequate financial status; disease-related factors were disease history, stroke subtype, and symptom severity. Age less than 75, female sex, comorbidity, antiplatelet medication switch, and polypharmacy were identified as factors of medication nonpersistence. CONCLUSIONS Stroke patients' medication persistence decreases over time, and persistence on antiplatelets, anticoagulants, and statin was poor. Several factors were associated with medication persistence, and these factors should be considered in future secondary preventative strategies.
Collapse
Affiliation(s)
- Dong Eun Jang
- School of Nursing, The University of Texas at Austin , Austin, TX, USA
| | - Julie Ann Zuñiga
- School of Nursing, The University of Texas at Austin , Austin, TX, USA
| |
Collapse
|
7
|
Alwhaibi M, Altoaimi M, AlRuthia Y, Meraya AM, Balkhi B, Aldemerdash A, Alkofide H, Alhawassi TM, Alqasoumi A, Kamal KM. Adherence to Statin Therapy and Attainment of LDL Cholesterol Goal Among Patients with Type 2 Diabetes and Dyslipidemia. Patient Prefer Adherence 2019; 13:2111-2118. [PMID: 31853174 PMCID: PMC6916674 DOI: 10.2147/ppa.s231873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Statins are widely utilized antidyslipidemics with a proven track record of safety and efficacy. However, the efficacy of these therapeutic agents hinges on patients' adherence to their prescribed statins. OBJECTIVE The primary objectives of this study were to examine the relationship between adherence to prescribed statins and its impact on the low-density lipoprotein (LDL) level, and to explore the factors that influence patient adherence to statins among patients with diabetes and dyslipidemia. METHODS This was a retrospective, cross-sectional study using the electronic health records data of adults (≥18 years) with type 2 diabetes and dyslipidemia visiting outpatient clinics at a university-affiliated tertiary care center. Adherence to statin therapy was estimated using the proportion of days covered (PDC). Patients with diabetes were considered adherent to statins if they had a PDC of ≥80%. Treatment success was considered if the LDL level of < 2.6 mmol/L. RESULTS Out of 10,226 of patients with diabetes, 1532 met the inclusion criteria and were included in the study. Seventy-nine percent of the patients with diabetes were on atorvastatin and 21% were on simvastatin. The vast majority of the patients with diabetes (77%) were considered adherent and about 42% achieved LDL-cholesterol goal < 2.6 mmol/L. No association between adherence to statin therapy and LDL goal attainment was observed. Women had lower odds of being adherent to statin therapy (AOR=0.66, 95% CI: 0.49-0.87) compared to men. Further, young adults (18-44 years) had lower odds of being adherent to statin therapy (AOR=0.58, 95% CI: 0.32-0.97) compared to older adults (age>65 years). CONCLUSION The findings of this study highlight the need to examine the impact of adherence to statins on healthcare services utilization due to different complications of uncontrolled dyslipidemia.
Collapse
Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Maha Altoaimi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim M Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Alqasoumi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Khalid M Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Wawruch M, Wimmer G, Murin J, Paduchova M, Tesar T, Hlinkova L, Slavkovsky P, Fabryova L, Aarnio E. Patient-Associated Characteristics Influencing the Risk for Non-Persistence with Statins in Older Patients with Peripheral Arterial Disease. Drugs Aging 2019; 36:863-873. [PMID: 31256366 DOI: 10.1007/s40266-019-00689-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Secondary prevention of peripheral arterial disease includes administration of statins regardless of the patient's serum cholesterol level. Our study aimed to identify patient-associated risk factors for statin non-persistence and comparison of the explanatory power of models based on clusters of patient-associated characteristics. METHODS Our study cohort (n = 8330) was assembled from the database of the largest health insurance provider in the Slovak Republic. Statin users aged ≥ 65 years in whom peripheral arterial disease was diagnosed during 2012 were included. Patients were followed for 5 years; those with a treatment gap period of at least 6 months without statin prescription were classified as "non-persistent". The risk factors for non-persistence were identified within six models (sociodemographic, cardiovascular events, comorbid conditions, statin-related characteristics, cardiovascular co-medication and full model) using Cox regression. The explanatory power of models was assessed using Harrell's C-index. RESULTS At the end of the follow-up, 35.7% of patients were found to be non-persistent. The full model had the highest explanatory power (C = 0.632). Female sex, atorvastatin and rosuvastatin as initially administered statins, being a new statin user and an increasing co-payment were associated with an increased risk for non-persistence. Increasing age, history of ischaemic stroke, diabetes mellitus, general practitioner as index prescriber, increasing overall number of medications and co-administration of certain cardiovascular co-medications were associated with a lower likelihood for non-persistence. CONCLUSIONS Patients identified as high risk for non-persistence require special attention aimed at the improvement of their persistence with statin treatment.
Collapse
Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
| | - Gejza Wimmer
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Odbojarov 10, 832 32, Bratislava, Slovakia.
| | | | - Peter Slavkovsky
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lubomira Fabryova
- Department of Diabetes and Metabolic Disorders, MetabolKLINIK, Bratislava, Slovakia
- Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Emma Aarnio
- Institute of Biomedicine, University of Turku, Turku, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
9
|
Yang Z, Edwards D, Massou E, Saunders CL, Brayne C, Mant J. Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study. Clin Epidemiol 2019; 11:495-508. [PMID: 31388316 PMCID: PMC6607979 DOI: 10.2147/clep.s201983] [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] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Trial evidence supports statin use after ischemic stroke and recent American, European and British guidelines recommend high-intensity statins for this indication. Limited data are available describing current statin use among these patients in unselected settings. We conducted a cohort study to examine secular trends and factors associated with statin use and dose following ischemic stroke. Methods: A retrospective cohort study of patients with first ischemic stroke between 2000 and 2014 was conducted using the Clinical Practice Research Datalink (CPRD). Proportions of statin users and high-intensity statin users within 2 years after stroke were estimated for each calendar year. We used Cox regression models to explore potential factors associated with statin use and Poisson regression models to calculate risk ratios for the use of a high-intensity statin. Results: A total of 80,442 patients with first stroke were analyzed. The proportion using statins within 2 years after stroke increased from 25% in 2000 to 70% in 2006 and remained at about 75% through 2014. Among post-stroke statin users, high-intensity use accounted for approximately 15% between 2004 and 2011 and then increased to almost 35% in 2014. Older patients (aged ≥75 years), younger patients (<45 years), patients with no prior statin treatment, dementia, underweight, or absence of cardiovascular factors (coronary heart disease, smoking, obesity, diabetes, hypertension, or transient ischemic attack) were less likely to use statins and less likely to receive a high-intensity statin. Conclusion: There has been an increase over time in both statin use and dose, but many patients with ischemic stroke continue to be under-treated. Clinical trials and policy interventions to improve appropriate post-stroke statin use should focus on younger and older patients, patients with no pre-stroke statin treatment, and patients without additional cardiovascular risk factors.
Collapse
Affiliation(s)
- Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Duncan Edwards
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Efthalia Massou
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Catherine L Saunders
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, Nelson M, Tonkin A, Liew D, Zoungas S. A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years. J Gerontol A Biol Sci Med Sci 2019; 73:798-805. [PMID: 29360935 DOI: 10.1093/gerona/glx256] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/01/2018] [Indexed: 02/02/2023] Open
Abstract
Background Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed. Methods We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques. Results Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15). Conclusion Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Division of Metabolism, Genomics and Ageing, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
11
|
Abstract
The evaluation of the real-life benefits and risks of statins in population is a major pharmacoepidemiological issue, given their widespread use for cardiovascular prevention. The purpose of this review was not to be exhaustive but to show the contributions of pharmacoepidemiology for various aspects of the evaluation of statins such as real-life drug use, effectiveness and risk. Statins are among the most used drugs in the world, but recent data show a slight decrease in use. Actual statin users are older, and have more comorbidities than those studied in clinical trials, but this does not seem to compromise their effectiveness, unlike the compliance issues that are common with these drugs. Beyond the known adverse reactions of statins from the clinical trials, risks of statins can be varied and sometimes difficult to evaluate, considering the ubiquity of cholesterol throughout the body, from drug or endogenous molecule metabolism to the construction of cell membranes or cell activities.
Collapse
Affiliation(s)
- Julien Bezin
- Inserm, UMR 1219, Bordeaux population health research center, team pharmacoepidemiology, université Bordeaux, 33076 Bordeaux, France.
| | - Nicholas Moore
- Inserm CIC1401, Inserm CR1219, Bordeaux PharmacoEpi, université et CHU de Bordeaux, 33076 Bordeaux, France
| |
Collapse
|
12
|
Ofori‐Asenso R, Ilomäki J, Tacey M, Si S, Curtis AJ, Zomer E, Bell JS, Zoungas S, Liew D. Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study. Br J Clin Pharmacol 2019; 85:227-235. [PMID: 30402916 PMCID: PMC6303220 DOI: 10.1111/bcp.13797] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/26/2018] [Accepted: 10/13/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. METHODS Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). RESULTS During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75-84 years and ≥85 years were more likely to discontinue than people aged 65-74 years (odds ratio 1.11, 95% confidence interval 1.04-1.19 and 1.38, 1.23-1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. CONCLUSIONS Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.
Collapse
Affiliation(s)
- Richard Ofori‐Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| |
Collapse
|
13
|
Yuan HW, Ji RJ, Lin YJ, Chen HF, Peng GP, Luo BY. Intensive Versus Moderate Statin Therapy Discontinuation in Patients With Acute Ischemic Stroke or Transient Ischemic Attack. Clin Ther 2018; 40:2041-2049. [PMID: 30420288 DOI: 10.1016/j.clinthera.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The differences of discontinuation risk between intensive and mild-to-moderate statin therapy in patients with acute ischemic stroke is not clear. This study aimed to clarify whether intensive statin therapy resulted in a significant increase in discontinuation early after discharge. METHODS This multicenter registry study enrolled consecutive hospitalized patients with ischemic stroke or transient ischemic attack. All the patients were prescribed statin therapy at discharge. Intensity of statin therapy was defined according to the 2013 American College of Cardiology/American Heart Association guideline on the treatment of blood cholesterol. A logistic regression model was used to analyze the association between statin therapy intensity and discontinuation. FINDINGS This study included 505 patients, of whom 64 and 441 received intensive and moderate statin therapy, respectively (mean follow-up, approximately 6 months). The rates of discontinuation of intensive and moderate statin therapy were 31.3% and 10.7% (P < 0.001), respectively. Variables with significant differences between the intensive and moderate statin therapy groups were included in the adjusted logistic regression model. Intensive statin therapy significantly increased discontinuation risk by 273.0% (odds ratio = 3.730; 95% CI, 2.013-6.911; P < .001) compared with moderate statin therapy. The result was consistent in most subgroups, except for patients with National Institutes of Health Stroke Scale scores ≥4. IMPLICATIONS In stroke secondary prevention, intensive statin therapy may significantly increase the risk of early discontinuation compared with moderate statin therapy. Future clinical trials that involve a comparison between intensive and moderate statin therapy for stroke secondary prevention should address the differences in discontinuation between these 2 groups.
Collapse
Affiliation(s)
- Huai Wu Yuan
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ren Jie Ji
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ya Jie Lin
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Han Feng Chen
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guo Ping Peng
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ben Yan Luo
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, China.
| |
Collapse
|
14
|
Byrne P, Cullinan J, Murphy C, Smith SM. Cross-sectional analysis of the prevalence and predictors of statin utilisation in Ireland with a focus on primary prevention of cardiovascular disease. BMJ Open 2018; 8:e018524. [PMID: 29439070 PMCID: PMC5829660 DOI: 10.1136/bmjopen-2017-018524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of statin utilisation by people aged over 50 years in Ireland and the factors associated with the likelihood of using a statin, focusing particularly on those using statins for primary prevention of cardiovascular disease (CVD). METHODS This is a cross-sectional analysis of cardiovascular risk and sociodemographic factors associated with statin utilisation from wave 1 of The Irish Longitudinal Study on Ageing. A hierarchy of indications for statin utilisation, consisting of eight mutually exclusive levels of CVD-related diagnoses, was created. Participants were assigned one level of indication. The prevalence of statin utilisation was calculated. The likelihood that an individual was using a statin was estimated using a multivariable logistic regression model, controlling for cardiovascular risk and sociodemographic factors. RESULTS In this nationally representative sample (n=5618) of community-dwelling participants aged 50 years and over, 1715 (30.5%) were taking statins. Of these, 65.0% (57.3% of men and 72.7% of women) were doing so for the primary prevention of CVD. Thus, almost two-thirds of those taking statins did so for primary prevention and there was a notable difference between women and men in this regard. We also found that statin utilisation was highest among those with a prior history of CVD and was significantly associated with age (compared with the base category 50-64 years; 65-74 years OR 1.38 (95% CI 1.16 to 1.65); 75+ OR 1.33 (95% CI 1.04 to 1.69)), living with a spouse or partner (compared with the base category living alone; OR 1.35 (95% CI 1.10 to 1.65)), polypharmacy (OR 1.74 (95% CI 1.39 to 2.19)) and frequency of general practitioner visits (compared with the base category 0 visits per year; 1-2 visits OR 2.46 (95% CI 1.80 to 3.35); 3-4 visits OR 3.24 (95% CI 2.34 to 4.47); 5-6 visits OR 2.98 (95% CI 2.08 to 4.26); 7+ visits OR 2.51 (95% CI 1.73 to 3.63)), even after controlling for clinical need. There was no association between using statins and gender, education, income, social class, health insurance status, location or Systematic Coronary Risk Evaluation (SCORE) risk in the multivariable analysis. CONCLUSION Statin utilisation among those with no history of CVD accounted for almost two-thirds of all statin use, in part reflecting the high proportion of the population with no history of CVD, although utilisation rates were highest among those with a history of CVD.
Collapse
Affiliation(s)
- Paula Byrne
- National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- National University of Ireland Galway, Galway, Ireland
| | - Catríona Murphy
- Dublin City University, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
15
|
Kim D, Choi JY, Cho SK, Choi CB, Bang SY, Cha HS, Choe JY, Chung WT, Hong SJ, Kim TH, Kim TJ, Koh E, Lee HS, Lee J, Lee SS, Lee SW, Park SH, Shim SC, Yoo DH, Yoon BY, Bae SC, Sung YK. Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Dam Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Soo-Kyung Cho
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Chan-Bum Choi
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Hoon-Suk Cha
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yoon Choe
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | | | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Jong Kim
- Chonnam National University Hospital, Gwangju, Korea
| | - Eunmi Koh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Jisoo Lee
- Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Shin-Seok Lee
- Chonnam National University Hospital, Gwangju, Korea
| | | | - Sung-Hoon Park
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | - Dae-Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Yoon-Kyoung Sung
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| |
Collapse
|
16
|
Rohde D, Merriman NA, Doyle F, Bennett K, Williams D, Hickey A. Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke. PLoS One 2017; 12:e0189339. [PMID: 29220386 PMCID: PMC5722379 DOI: 10.1371/journal.pone.0189339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke. METHODS A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO. RESULTS From 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall evidence quality was low. CONCLUSIONS Few studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.
Collapse
Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
17
|
Choi KH, Yu YM, Ah YM, Chang MJ, Lee JY. Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:232. [PMID: 28836946 PMCID: PMC5571581 DOI: 10.1186/s12872-017-0665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the medication-taking behavior in very elderly hypertensive patients. The aim of this study was to evaluate the persistence and adherence with antihypertensive agents in treatment-naïve patients, along with other related factors, according to age. METHODS Adult (19-64 years), elderly (65-79 years), and very elderly (≥80 years) uncomplicated hypertensive patients starting antihypertensive monotherapy were identified from the National Health Insurance claims database. The first-year treatment persistence and adherence rates measured using the medication possession ratio were assessed and compared in these three age cohorts. RESULTS After propensity score matching, three age cohorts with 6689 patients each were assembled from 228,925 uncomplicated hypertensive patients who began antihypertensive monotherapy in 2012. The treatment persistence and adherence rates over the first year were the lowest in the very elderly (59.5% and 62.8%, respectively) and highest in the elderly (65.2% and 67.9%, respectively) patients among the three age cohorts (p < 0.001). The adjusted risk for treatment non-persistence was significantly higher in the very elderly (adjusted hazard ratio, 1.20; 95% confidence interval, 1.13-1.27) compared with the elderly. Having more comorbidities, being a beneficiary of medical aid, and having a diagnosis of dementia were unique positive predictors for treatment persistence in the very elderly, along with common predictors such as female sex, dyslipidemia, and an initially chosen antihypertensive therapeutic class other than beta blockers and thiazide diuretics. CONCLUSIONS Very elderly patients were less likely to continue antihypertensive therapy over the first year compared with their younger counterparts. Our findings suggest that a low comorbidity index and lack of medical aid support negatively affect the treatment persistence in this population.
Collapse
Affiliation(s)
- Kyung Hee Choi
- College of Pharmacy, Sunchon National University, 255 Jungang-ro, Suncheon, Jeollanam-do, 57922, South Korea.,College of Pharmacy, Chonnam National University, Gwang-Ju, 61186, South Korea
| | - Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea
| | - Min Jung Chang
- College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, 21983, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea.
| |
Collapse
|
18
|
Wawruch M, Zatko D, Wimmer G, Luha J, Wimmerova S, Matalova P, Kukumberg P, Murin J, Tesar T, Havelkova B, Shah R. Age-Related Differences in Non-Persistence with Statin Treatment in Patients after a Transient Ischaemic Attack. Clin Drug Investig 2017; 37:1047-1054. [DOI: 10.1007/s40261-017-0559-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|