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Kariis HM, Kasela S, Jürgenson T, Saar A, Lass J, Krebs K, Võsa U, Haan E, Milani L, Lehto K. The role of depression and antidepressant treatment in antihypertensive medication adherence and persistence: Utilising electronic health record data. J Psychiatr Res 2023; 168:269-278. [PMID: 37924579 DOI: 10.1016/j.jpsychires.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Higher blood pressure levels in patients with depression may be associated with lower adherence to antihypertensive medications (AHMs). Here, we use electronic health record (EHR) data from the Estonian Biobank (EstBB) to investigate the role of lifetime depression in AHM adherence and persistence. We also explore the relationship between antidepressant initiation and intraindividual change in AHM adherence among hypertension (HTN) patients with newly diagnosed depression. Diagnosis and pharmacy refill data were obtained from the National Health Insurance database. Adherence and persistence to AHMs were determined for hypertension (HTN) patients initiating treatment between 2009 and 2017 with a three-year follow-up period. Multivariable regression was used to explore the associations between depression and AHM adherence or persistence, adjusting for sociodemographic, genetic, and health-related factors. A linear mixed-effects model was used to estimate the effect of antidepressant treatment initiation on antihypertensive medication adherence, adjusting for age and sex. We identified 20,724 individuals with newly diagnosed HTN (6294 depression cases and 14,430 controls). Depression was associated with 6% lower probability of AHM adherence (OR = 0.943, 95%CI = 0.909-0.979) and 12% lower odds of AHM persistence (OR = 0.876, 95%CI = 0.821-0.936). Adjusting for sociodemographic, genetic, and health-related factors did not significantly influence these associations. AHM adherence increased 8% six months after initiating antidepressant therapy (N = 132; β = 0.078; 95%CI = 0.025-0.131). Based on the EHR data on EstBB participants, depression is associated with lower AHM adherence and persistence. Additionally, antidepressant therapy may help improve AHM adherence in patients with depression.
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Affiliation(s)
- Hanna Maria Kariis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Silva Kasela
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Tuuli Jürgenson
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Aet Saar
- North Estonia Medical Centre, J. Sütiste Street 19, Tallinn, 13419, Harjumaa, Estonia
| | - Jana Lass
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia; Tartu University Hospital, L. Puusepa 8, Tartu, 50406, Tartumaa, Estonia
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Elis Haan
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia.
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Dodson JA, Schoenthaler A, Fonceva A, Gutierrez Y, Shimbo D, Banco D, Maidman S, Olkhina E, Hanley K, Lee C, Levy NK, Adhikari S. Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200156. [PMID: 36573193 PMCID: PMC9789360 DOI: 10.1016/j.ijcrp.2022.200156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/19/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Background Nonadherence to antihypertensive medications remains a persistent problem that leads to preventable morbidity and mortality. Behavioral economic strategies represent a novel way to improve antihypertensive medication adherence, but remain largely untested especially in vulnerable populations which stand to benefit the most. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) was designed in this context, to test whether a digitally-enabled incentive lottery improves antihypertensive adherence and reduces systolic blood pressure (SBP). Design BETTER-BP is a pragmatic randomized trial conducted within 3 safety-net clinics in New York City: Bellevue Hospital Center, Gouveneur Hospital Center, and NYU Family Health Centers - Park Slope. The trial will randomize 435 patients with poorly controlled hypertension and poor adherence (<80% days adherent) in a 2:1 ratio (intervention:control) to receive either an incentive lottery versus passive monitoring. The incentive lottery is delivered via short messaging service (SMS) text messages that are delivered based on (1) antihypertensive adherence tracked via a wireless electronic monitoring device, paired with (2) a probability of lottery winning with variable incentives and a regret component for nonadherence. The study intervention lasts for 6 months, and ambulatory systolic blood pressure (SBP) will be measured at both 6 and 12 months to evaluate immediate and durable lottery effects. Conclusions BETTER-BP will generate knowledge about whether an incentive lottery is effective in vulnerable populations to improve antihypertensive medication adherence. If successful, this could lead to the implementation of this novel strategy on a larger scale to improve outcomes.
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Affiliation(s)
- John A. Dodson
- NYU Langone Medical Center, New York, NY, USA
- Corresponding author. New York University Grossman School of Medicine, 227 East 30th Street, TRB 851, New York, NY, 10016, USA.
| | | | - Ana Fonceva
- NYU Langone Medical Center, New York, NY, USA
| | | | - Daichi Shimbo
- Columbia University Irving Medical Center, New York, NY, USA
| | - Darcy Banco
- NYU Langone Medical Center, New York, NY, USA
| | | | | | | | - Carson Lee
- NYU Langone Medical Center, New York, NY, USA
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Xia JH, Zhang DY, Kang YY, Guo QH, Cheng YB, Huang JF, Huang QF, Zhang W, Zhang LJ, Dou Y, Su YL, Liu HL, Zheng MS, Xu XJ, Mu JJ, Li Y, Wang JG. The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China. Hypertens Res 2022; 45:1690-1700. [DOI: 10.1038/s41440-022-01005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
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Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
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Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
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Krousel-Wood M, Peacock E, Bradford WD, Mohundro B, Craig LS, O'Connell S, Bazzano L, Shi L, Ford M. Time Preference for Immediate Gratification: Associations With Low Medication Adherence and Uncontrolled Blood Pressure. Am J Hypertens 2022; 35:256-263. [PMID: 34788786 DOI: 10.1093/ajh/hpab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In search of innovative approaches to the challenge of uncontrolled hypertension, we assessed the association between preference for immediate gratification (i.e., high discounting rate), low medication adherence, and uncontrolled blood pressure (BP) in adults with hypertension. METHODS Using a probability discounting model and the Collier-Williams hypothetical discount rate framework, participants in this cross-sectional study reported their preference for a smaller amount of money available immediately (high discount rate; immediate gratification preference) vs. a larger amount available 1 year later (low discount rate; delayed gratification preference). Multivariable Poisson regression was used to test the association of high discounting rates with low antihypertensive medication adherence using the validated 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4 score ≥1). Mediation of the association between high discounting rate and uncontrolled BP (systolic/diastolic BP ≥ 130/80 mm Hg) by low adherence was tested using the counterfactual approach. RESULTS Among 235 participants (mean age 63.7 ± 6.7 years; 51.1% women; 41.9% Black), 50.6% had a high 1-year discount rate, 51.9% had low K-Wood-MAS-4 adherence, and 59.6% had uncontrolled BP. High discounting rates were associated with low adherence (adjusted prevalence ratio 1.58, 95% confidence interval (CI) 1.18, 2.12). Forty-three percent (95% CI 40.9%, 45.8%) of the total effect of high discount rate on uncontrolled BP was mediated by low adherence. CONCLUSIONS Adults with preference for immediate gratification had worse adherence; low adherence partially mediated the association of high discount rate with uncontrolled BP. These results support preference for immediate gratification as an innovative factor underlying low medication adherence and uncontrolled BP.
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Affiliation(s)
- Marie Krousel-Wood
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Erin Peacock
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - W David Bradford
- Department of Public Administration and Policy, University of Georgia School of Public and International Affairs, Athens, Georgia, USA
| | - Brice Mohundro
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Leslie S Craig
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O'Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Milam Ford
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
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Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus 2021; 13:e17929. [PMID: 34660121 PMCID: PMC8513498 DOI: 10.7759/cureus.17929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/22/2023] Open
Abstract
The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.
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Affiliation(s)
- Enrique Arredondo
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - George Udeani
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Michael Horseman
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Trager D Hintze
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
- Medicine, College of Medicine, Texas A&M Health Science Center, Bryan, USA
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Chudek A, Owczarek AJ, Ficek J, Olszanecka-Glinianowicz M, Wieczorowska-Tobis K, Walencka Z, Almgren-Rachtan A, Chudek J. A Stronger Effect of Body Mass Index and Waist Circumference on the Prevalence of Uncontrolled Hypertension among Caucasian Men than Women. Kidney Blood Press Res 2021; 46:298-309. [PMID: 33882485 DOI: 10.1159/000514346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender-related differences in fat distribution may affect blood pressure (BP) control in hypertensive subjects. The aim of the study was to assess how body mass (BM), BMI, and waist circumference (WC) influence the effectiveness of antihypertension therapy in hypertensive men and women in daily clinical practice. PATIENTS AND METHODS The observational study involved 12,289 adult hypertensive Caucasians (6,163 women) declaring regular use of antihypertensive drugs. BP control was scored based on the mean values of 2 attended office BP measurements. WC thresholds for visceral obesity were adopted from definitions of the International Diabetes Federation (≥94/80 cm for men/women) and National Cholesterol Education Program Adult Treatment Panel III (≥102/88 cm for men/women). Stepwise backward multivariable logistic regression was used to analyse correlates of the effectiveness of hypertension therapy. RESULTS The predictive value of BMI ≥30 (for uncontrolled hypertension) was stronger than that of visceral obesity, regardless of the criteria used. In men, BP control rapidly deteriorated with BMI (odds ratio [OR] up to 8.58 [95% CI: 5.74-12.83]) and WC (OR up to 5.09 [3.84-6.74]), while in women, the association was more flattened (OR up to 3.63 [2.78-4.74] and 1.93 [1.59-2.35], respectively). However, the highest risk of uncontrolled BP occurred in women with BM ≥110 kg (OR = 10.47 [5.05-21.71]) and men with BM ≥125 kg (OR = 9.66 [5.86-15.94]). CONCLUSIONS (1) Obesity and visceral obesity limit the effectiveness of antihypertension therapy more in men than in women. (2) This phenomenon should be taken into account in the prescription of adequate doses of antihypertensive drugs.
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Affiliation(s)
- Anna Chudek
- Department of Pharmacovigilance, Europharma Rachtan Co. Ltd, Katowice, Poland
| | - Aleksander Jerzy Owczarek
- Department of Statistics, Department of Instrumental Analysis, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Joanna Ficek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Wieczorowska-Tobis
- Laboratory for Geriatric Medicine, Department of Palliative Medicine, University of Medical Sciences, Poznan, Poland
| | - Zofia Walencka
- Department of Pharmacovigilance, Europharma Rachtan Co. Ltd, Katowice, Poland.,Department of Neonatology School of Medicine, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
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Craig LS, Peacock E, Mohundro BL, Silver JH, Marsh J, Johnson TC, Kelly PA, Bazzano LA, Cunningham M, Petty RE, Krousel‐Wood M. Implicit and Explicit Attitudes Toward Antihypertensive Medications Explain Variation in Pharmacy Refill and Self-Reported Adherence Beyond Traditional Risk Factors: Potential Novel Mechanism Underlying Adherence. J Am Heart Assoc 2021; 10:e018986. [PMID: 33660523 PMCID: PMC8174192 DOI: 10.1161/jaha.120.018986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022]
Abstract
Background In pursuit of novel mechanisms underlying persistent low medication adherence rates, we assessed contributions of implicit and explicit attitudes, beyond traditional risk factors, in explaining variation in objective and subjective antihypertensive medication adherence. Methods and Results Implicit and explicit attitudes were assessed using the difference scores from the computer-based Single Category Implicit Association Test and the Necessity and Concerns subscales of the Beliefs about Medicines Questionnaire, respectively. Antihypertensive medication adherence was measured using pharmacy refill proportion of days covered (PDC: mean PDC, low PDC <0.8) and the self-report 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4: mean K-Wood-MAS-4, low adherence via K-Wood-MAS-4 ≥1). Hierarchical logistic and linear regression models controlled for traditional risk factors including social determinants of health, explicit, and implicit attitudes in a stepwise fashion. Community-dwelling insured participants (n=85: 44.7% female; 20.0% Black; mean age, 62.3 years; 43.5% low PDC, and 31.8% low adherence via K-Wood-MAS-4) had mean (SD) explicit and implicit attitude scores of 7.188 (5.683) and 0.035 (0.334), respectively. Low PDC was inversely associated with more positive explicit (adjusted odds ratio [aOR], 0.87; 95% CI, 0.78-0.98; P=0.022) and implicit (aOR, 0.12; 95% CI, 0.02-0.80; P=0.029) attitudes, which accounted for an additional 8.6% (P=0.016) and 6.5% (P=0.029) of variation in low PDC, respectively. Lower mean K-Wood-MAS-4 scores (better adherence) were associated only with more positive explicit attitudes (adjusted β, -0.04; 95% CI, -0.07 to -0.01; P=0.026); explicit attitudes explained an additional 5.6% (P=0.023) of K-Wood-MAS-4 variance. Conclusions Implicit and explicit attitudes explained significantly more variation in medication adherence beyond traditional risk factors, including social determinants of health, and should be explored as potential mechanisms underlying adherence behavior.
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Affiliation(s)
- Leslie S. Craig
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Erin Peacock
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | | | - Julia H. Silver
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - James Marsh
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Taylor C. Johnson
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - P. Adam Kelly
- Department of MedicineTulane University School of MedicineNew OrleansLA
- Southeast Louisiana Veterans Health Care SystemNew OrleansLA
| | - Lydia A. Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | - Michael Cunningham
- Department of PsychologyTulane University School of Science and EngineeringNew OrleansLA
| | | | - Marie Krousel‐Wood
- Department of MedicineTulane University School of MedicineNew OrleansLA
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
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Wei J, Mi Y, Li Y, Xin B, Wang Y. Factors associated with awareness, treatment and control of hypertension among 3579 hypertensive adults in China: data from the China Health and Nutrition Survey. BMC Public Health 2021; 21:423. [PMID: 33648483 PMCID: PMC7919311 DOI: 10.1186/s12889-021-10417-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 02/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is high and rising in China, but most people with hypertension do not have their blood pressure under control. This study investigated hypertension awareness, treatment, and control and their associated factors among Chinese adults. METHODS Data collected from the 2011 China Health and Nutrition Survey (CHNS) from 12,991 Chinese adults were used. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported prior diagnosed hypertension, or taking antihypertensive medications. Hypertension awareness, treatment, and control were defined as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure < 140/90 mmHg, respectively. Multivariate logistic regression was performed to examine factors associated with hypertension awareness, treatment, and control. RESULTS Overall, 3579 (27.6%) of the CHNS adult participants had hypertension, of whom 55.7% were aware of their diagnosis, 46.5% were treated with antihypertensive medications, but only 20.3% had their blood pressure under control. Higher hypertension treatment was associated with older age (OR = 2.57; 95%CI, 1.65-4.02), urban residency (1.50; 1.14-1.97), living in the Eastern region (1.52; 1.14-2.01), and being overweight/obese (1.99; 1.39-2.84). Hypertension awareness was associated with similar factors as hypertension treatment but was also associated with being female (1.37, 1.12-1.66). Poor hypertension control was associated with being overweight/obese (0.56; 0.42-0.76) and minority ethnicity (0.52; 0.31-0.86). CONCLUSION Hypertension is a major public health challenge in China. The prevalence of hypertension awareness, treatment, and control are still low despite existing public health policies and programs to reduce the burden of hypertension. More intensive hypertension screening and treatment programs are warranted in China.
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Affiliation(s)
- Junxiang Wei
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, China.
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Yang Mi
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bo Xin
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Youfa Wang
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Chou CP, Chen CY, Huang KS, Lin SC, Huang CF, Koo M. Factors associated with nonadherence to antihypertensive medication among middle-aged adults with hypertension: findings from the Taiwan National Health Interview Survey. J Int Med Res 2020. [PMCID: PMC7418250 DOI: 10.1177/0300060520936176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to investigate factors associated with nonadherence to
antihypertensive medication among middle-aged Taiwanese adults with
hypertension. Methods We used data from the 2009 Taiwan National Health Interview Survey (NHIS) to
identify adults age 40 to 65 years with hypertension. We used logistic
regression analyses to investigate factors associated with nonadherence to
antihypertensive medication. Results A total 1,256 respondents with hypertension taking antihypertensive
medication were included in this study. Multiple logistic regression
analyses revealed that six factors were significantly and independently
associated with nonadherence to medication: younger age (odds ratio,
[OR] = 1.85), mean monthly personal income < TWD 20,000 (USD 660)
(OR = 1.87), outpatient medical services use in the past month (OR = 0.57),
hospitalization in the past year (OR = 1.70), diabetes or dyslipidemia
(OR = 0.63), and alcohol use in the past month (OR = 2.38). Conclusions This secondary data analysis of the population-based NHIS identified six
factors associated with nonadherence to antihypertensive medication. These
factors should be considered when planning and implementing blood pressure
control interventions among middle-aged adults with hypertension.
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Affiliation(s)
- Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung City
| | - Chun-Yu Chen
- Department of Family Medicine, Kaohsiung Municipal Gangshan Hospital, Kaohsiung City
| | - Kun-Siang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
| | - Shih-Chun Lin
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi
| | - Chih-Fang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Department of Long Term Care and Management, Chung Hwa University of Medical Technology, Tainan City
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Cyrus AC, Royer J, Carroll DD, Courtney-Long EA, McDermott S, Turk MA. Anti-Hypertensive Medication Use and Factors Related to Adherence Among Adults With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:248-262. [PMID: 31026202 PMCID: PMC6554647 DOI: 10.1352/1944-7558-124.3.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adults with intellectual and developmental disabilities (IDD) are known to experience significant health disparities; however, few studies have described anti-hypertensive medication adherence in this population. Using administrative data from South Carolina from 2000-2014, we evaluated the odds of adherence to anti-hypertensive medication among a cohort of adults with IDD and hypertension. Approximately half (49.5%) of the study cohort were adherent to anti-hypertensive medication. Those who lived in a supervised residence, had a Medicaid waiver, and had more frequent contact with a primary care provider were more likely to be adherent. Organizations that serve people with IDD have an opportunity to increase adherence by educating these individuals, their family members, and caregivers about the importance of adherence to anti-hypertensive medication.
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Affiliation(s)
- Alissa C Cyrus
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Julie Royer
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Dianna D Carroll
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Elizabeth A Courtney-Long
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Suzanne McDermott
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Margaret A Turk
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
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Adherence of Elderly Patients with Cardiovascular Disease to Statins and the Risk of Exacerbation of Chronic Obstructive Pulmonary Disease: Evidence from an Italian Real-World Investigation. Drugs Aging 2018; 35:1099-1108. [DOI: 10.1007/s40266-018-0600-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Feldman CH, Collins J, Zhang Z, Subramanian SV, Solomon DH, Kawachi I, Costenbader KH. Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus. Semin Arthritis Rheum 2018; 48:205-213. [PMID: 29458974 PMCID: PMC6035896 DOI: 10.1016/j.semarthrit.2018.01.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/21/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is the standard of care medication for most SLE patients, however nonadherence is common. We investigated longitudinal patterns and predictors of nonadherence to HCQ in a U.S. SLE cohort of HCQ initiators. METHODS We used Medicaid data from 28 states to identify adults 18-65 years with prevalent SLE. We included HCQ initiators following ≥6 months without use, and required ≥1 year of follow-up after first dispensing (index date). We used the proportion of days covered (PDC) to describe overall HCQ adherence (<80% = nonadherent) and novel group-based trajectory models (GBTM) to examine monthly patterns (<80% of days/month covered = nonadherent), during the first year of use. Multivariable multinomial logistic regression models were used to examine predictors of nonadherence. RESULTS We identified 10,406 HCQ initiators with SLE. Mean age was 38 (±12) years, 94% were female, 42% black, 31% white; 85% had a mean PDC < 80%. In our 4-group GBTM, 17% were persistent adherers, 36% persistent nonadherers, and 47% formed two dynamic patterns of partial adherence. Adherence declined for most patients over the first year. Compared to persistent adherers, the odds of nonadherence were increased for blacks and Hispanics vs. whites and for younger ages vs. older; increased SLE-related comorbidities were associated with reduced odds of nonadherence for persistent nonadherers (0.95, 95% CI: 0.91-0.99). CONCLUSIONS Among HCQ initiators with SLE, we observed poor adherence which declined for most over the first year of use. HCQ adherence is a dynamic behavior and further studies of associated predictors, outcomes, and interventions should reflect this.
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Affiliation(s)
- Candace H Feldman
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Jamie Collins
- Department of Orthopedic Surgery, The Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Brigham and Women's Hospital, Boston, MA
| | - Zhi Zhang
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Lefort M, Neufcourt L, Pannier B, Vaïsse B, Bayat S, Grimaud O, Girerd X. Sex differences in adherence to antihypertensive treatment in patients aged above 55: The French League Against Hypertension Survey (FLAHS). J Clin Hypertens (Greenwich) 2018; 20:1496-1503. [DOI: 10.1111/jch.13387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mathilde Lefort
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Lola Neufcourt
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Bruno Pannier
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
| | - Bernard Vaïsse
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
- Service de Cardiologie: Rythmologie et HTA; Marseille Cedex France
| | - Sahar Bayat
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449; Rennes France
| | - Xavier Girerd
- Comité Français de Lutte Contre l’Hypertension Artérielle (CFLHTA); Paris France
- Sorbonne Université, Assistance Publique des Hôpitaux de Paris, Unité de Prévention Cardio- Vasculaire. Hôpital de La Pitié-Salpêtrière; Paris Cedex France
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Zhang Y, Li X, Mao L, Zhang M, Li K, Zheng Y, Cui W, Yin H, He Y, Jing M. Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China. Patient Prefer Adherence 2018; 12:803-812. [PMID: 29785095 PMCID: PMC5955046 DOI: 10.2147/ppa.s158662] [Citation(s) in RCA: 11] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis. PATIENTS AND METHODS A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ2-test and a binary logistic regression model. RESULTS This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications. CONCLUSION Community management plays an important role in improving the patients' medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.
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Affiliation(s)
- Yuji Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xiaoju Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Lu Mao
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Ke Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yinxia Zheng
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wangfei Cui
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Hongpo Yin
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yanli He
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mingxia Jing
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Surbhi S, Graetz I, Wan JY, Gatwood J, Bailey JE. The Effect of Opioid Use and Mental Illness on Chronic Disease Medication Adherence in Superutilizers. J Manag Care Spec Pharm 2018; 24:198-207. [PMID: 29485952 PMCID: PMC10397787 DOI: 10.18553/jmcp.2018.24.3.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nonadherence to essential chronic medications has been identified as a potential driver of high health care costs in superutilizers of inpatient services. Few studies, however, have documented the levels of nonadherence and factors associated with nonadherence in this high-cost, vulnerable population. OBJECTIVE To examine the factors associated with nonadherence to essential chronic medications, with special emphasis on mental illness and use of opioid medications. METHODS This study was a retrospective panel analysis of 2-year baseline data for Medicare Part D beneficiaries eligible for the SafeMed care transitions program in Memphis, Tennessee, from February 2013 to December 2014. The 2-year baseline data for each patient were divided into four, 6-month patient periods. The study included Medicare superutilizers (defined as patients with ≥ 3 hospitalizations or ≥ 2 hospitalizations with ≥ 2 emergency visits in 6 months) with continuous Part D coverage who had filled at least 1 drug class used to treat hypertension, diabetes mellitus, congestive heart failure, coronary artery disease, or chronic lung disease. The outcome included medication nonadherence assessed using proportion of days covered (PDC), with PDC < 80% defined as nonadherent, and the main exposure variables included mental illness (defined as a diagnosis of depression or anxiety or ≥ 1 anxiolytic or antidepressant fill) and opioid medication fills assessed in each 6-month period. Pooled observations from the four 6-month periods were used for multivariable analyses using the patient periods as the unit of analysis. A random effects model with robust standard errors and a binary distribution were used to examine associations between independent variables (time invariant and time variant factors) and medication nonadherence. The model included lagged effects of time variant factors measured in each period. RESULTS Overall nonadherence to essential chronic medications ranged from 39.3% to 58.4%, with the highest for chronic lung disease medications (49.1%-64.4%). Factors associated with nonadherence included ≥ 4 opioid medication fills in the previous 6-month period (adjusted odds ratio [OR] = 1.90, 95% CI = 1.32-2.73); age 22-44 and 45-64 years vs. ≥ 65 years (OR = 3.57, 95% CI = 2.07-6.16, and OR = 2.07, 95% CI = 1.49-2.88); and a higher number of unique prescribers (OR = 1.10, 95% CI = 1.04-1.17). Factors protecting against nonadherence included higher number of unique medications filled (OR = 0.95, 95% CI = 0.92-0.98) and ≥ 1 physician office visit in the previous 6-month period (OR = 0.66, 95% CI = 0.46-0.94). CONCLUSIONS This study demonstrated that high levels of opioid medication use are significantly associated with essential chronic disease medication nonadherence among superutilizers. Other risk factors for nonadherence were aged < 65 years, low-income status, and a higher number of unique prescribers. Factors protecting against nonadherence were physician office visits and filling higher number of medications. Medication management interventions targeting superutilizers should focus on supporting chronic disease medication adherence. DISCLOSURES This project was supported by Funding Opportunity Number 1C1CMS331067-01-00 from the Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. Support was also provided by the Pharmaceutical Research and Manufacturers of America Foundation. The content of this study is solely the responsibility of the authors. The authors declare no relevant conflicts of interest or financial relationships. Study concept and design were contributed by Surbhi, Bailey, and Graetz. Surbhi and Wan collected the data, and data interpretation was performed primarily by Surbhi, along with Graetz, Bailey, and Gatwood. The manuscript was primarily written by Surbhi, with assistance from Bailey and Graetz, and revised by Bailey, Graetz, Gatwood, and Surbhi. This study was presented as a poster at the Academy Health Annual Research Meeting in Boston, Massachusetts, on June 26-28, 2016.
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Affiliation(s)
- Satya Surbhi
- Center for Health System Improvement, Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Jim Y. Wan
- Department of Medicine-General Internal Medicine and Urology, University of Tennessee Health Science Center, Memphis
| | - Justin Gatwood
- Clinical Pharmacy, University of Tennessee Health Science Center, Memphis
| | - James E. Bailey
- Departments of Medicine and Preventive Medicine, University of Tennessee Health Science Center, Memphis
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van der Laan DM, Elders PJM, Boons CCLM, Beckeringh JJ, Nijpels G, Hugtenburg JG. Factors associated with antihypertensive medication non-adherence: a systematic review. J Hum Hypertens 2017; 31:687-694. [PMID: 28660885 DOI: 10.1038/jhh.2017.48] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 11/08/2022]
Abstract
Non-adherence to antihypertensive medication is the most important cause of uncontrolled blood pressure and is influenced by multiple interrelating factors. Understanding the complexity of medication non-adherence and its associated factors is important to determine intervention strategies. Therefore, a systematic review was performed aimed to identify factors associated with antihypertensive medication non-adherence. Different databases were searched for observational studies reporting on factors associated with non-adherence to antihypertensive medication. Titles, abstracts and full texts were reviewed by three researchers. Subsequently, the methodological quality of each study was assessed. Factors that were extracted from the included studies were categorised as factors with consistent or inconsistent evidence to put their potential importance into perspective. Forty-four studies were included. Higher co-payment, side effects and a poor patient-provider relationship were identified as factors with consistent evidence since consistent significant relationships were found for these factors whenever studied. The relationships between non-adherence and multiple other factors were inconsistent among the reviewed studies. However, some of these factors deserve some consideration. Since multiple potentially relevant factors were identified, patient-tailored interventions focussing on identifying and addressing patients' specific barriers to adherence are needed. Further research should clarify the influence of inconsistent factors on adherence and their potential to be addressed in interventions.
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Affiliation(s)
- D M van der Laan
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - P J M Elders
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice &Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C C L M Boons
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - J J Beckeringh
- Westwijk Pharmaceutics BV, Kamillelaan 1, Amstelveen, The Netherlands
| | - G Nijpels
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice &Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice &Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
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18
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Rea F, Bonassi S, Vitale C, Trifirò G, Cascini S, Roberto G, Chinellato A, Lucenteforte E, Mugelli A, Corrao G. Exposure to statins is associated to fracture risk reduction in elderly people with cardiovascular disease: evidence from the AIFA-I-GrADE observational project. Pharmacoepidemiol Drug Saf 2017; 26:775-784. [PMID: 28370905 DOI: 10.1002/pds.4206] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/07/2017] [Accepted: 03/12/2017] [Indexed: 11/10/2022]
Abstract
PURPOSE Conflicting findings were observed from clinical trials and observational studies evaluating the association between the use of statins and the risk of fracture. A case-control study nested into a cohort of elderly patients on treatment with statins for cardiovascular secondary prevention was performed on this issue. METHODS The cohort was formed by 13 875 individuals aged ≥65 years from several Italian health units receiving statins after hospital discharge for cardiovascular outcomes. From this cohort, 964 patients who experienced fracture were identified (i.e., cases). Up to five controls were randomly selected for each case from the underlying cohort. Conditional logistic regression was used to model the risk of fracture associated with adherence to statins, which was measured from the proportion of days covered (PDC) by treatment. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty. RESULTS Compared with patients with low adherence (PDC ≤ 40%), those on intermediate (PDC 41-80%) and high (PDC > 80%) adherence exhibited a risk reduction of 21% (95% confidence interval 6% to 23%) and 25% (7% to 40%). Similar effects were observed among patients younger and older than 80 years, as well as among men, while there was no evidence that adherence to statins affected the risk of fracture among women. Sensitivity analyses revealed that the associations were consistent and robust. CONCLUSIONS Use of statins for secondary cardiovascular prevention is associated with fracture risk reduction in elderly people. Further studies are required to better clarify the statin-fracture association in postmenopausal women. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Federico Rea
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Stefano Bonassi
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy.,Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Cristiana Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Silvia Cascini
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Giuseppe Roberto
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | | | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Mejia CR, Failoc-Rojas VE, So E, Cervantes C, Aspajo AJ, Leandro JG, Cordova-De La Cruz J, Charri JC, García-Auqui KE, Coronel-Chucos LG, Justo-Pinto LD, Mamani-Apaza MS, Paz-Campos NA, Correa R. Characteristics and Factors Associated With Antihypertensive Medication Use in Patients Attending Peruvian Health Facilities. Cureus 2017; 9:e1011. [PMID: 28331773 PMCID: PMC5338991 DOI: 10.7759/cureus.1011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction Hypertension is a very common disease worldwide, and medication is needed to prevent its short-term and long-term complications. Our objective was to determine the characteristics and factors associated with antihypertensive medication use in patients attending Peruvian health facilities. Materials & Methods We performed a multicenter, cross-sectional study with secondary data. We obtained self-reported antihypertensive medication from patients attending health facilities in 10 departments of Peru. We looked for associations of the antihypertensive treatment according to sociopathological factors and obtained p values using generalized linear models. Results Of the 894 patients with hypertension, 61% (547) were women and 60% (503) were on antihypertensive treatment, of which 82% (389) had monotherapy and 52% (258) had recently taken their medication. Antihypertensive treatment was positively correlated with the patient's age (adjusted prevalence ratio [aPR]: 1.01; 95% confidence interval [CI]: 1.007 to 1.017; p value < 0.001), diabetes (aPR: 1.31; 95% CI: 1.11 to 1.55; p value = 0.001) and cardiovascular disease (aPR: 1.38; 95% CI: 1.26 to 1.51; p value < 0.001). Conversely, the frequency of antihypertensive treatment decreases with physical activity (aPR: 0.80; 95% CI: 0.70 to 0.92; p value = 0.001). Conclusion Patients who have comorbidities and advanced age are more likely to be on antihypertensive treatment. In contrast, patients with increased physical activity have a lower frequency of antihypertensive treatment. It is important to consider these factors for future preventive programs and to improve therapeutic compliance.
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Affiliation(s)
| | | | - Edison So
- Endocrinology and Metabolism, The Warren Alpert Medical School of Brown University
| | | | - Antonio J Aspajo
- Medicine, Universidad Nacional de la Amazonía Peruana. Loreto, Peru
| | | | | | - Julio C Charri
- Medicine, Universidad Nacional Daniel Alcides Carrión. Cerro de Pasco, Peru
| | - Kevin E García-Auqui
- Medicine, Sociedad Científica de Estudiantes de Medicina del Centro, Universidad Nacional del Centro del Perú. Huancayo, Junín, Perú
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Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, Chung N, Fleming M. A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm 2016; 22:63-73. [PMID: 27015053 PMCID: PMC10397653 DOI: 10.18553/jmcp.2016.22.1.63] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with comorbid hypertension (HTN) and diabetes mellitus (DM) are at a high risk of developing macrovascular and microvascular complications of DM. Controlling high blood pressure can greatly reduce these complications. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are recommended for patients with both DM and HTN by the American Diabetes Association guidelines, and their benefit and efficacy in reducing macrovascular and microvascular complications of DM have been well documented. Poor adherence, however, remains a significant barrier to achieving full effectiveness and optimal outcomes. OBJECTIVE To examine the effect of a brief pharmacist telephone intervention in identifying adherence barriers and improving adherence to ACEI/ARB medications among nonadherent patients with comorbid HTN and DM who are enrolled in a Medicare Advantage plan. METHODS Cigna-HealthSpring's medical claims data was used to identify patients with HTN and DM diagnoses by using ICD-9-CM codes 401 and 250, and at least 2 fills for ACEIs or ARBs between January 2013 and October 2013. Patients who failed to refill their medication for more than 1 day and had a proportion of days covered (PDC) < 0.8 were considered nonadherent and were contacted by a pharmacist by phone to identify adherence barriers. Two outcome variables were evaluated: The first was adherence to ACEIs/ARBs, defined as PDC during the 6 months following the phone call intervention. The second outcome variable was a categorical outcome of discontinuation versus continuation. Discontinuation was defined as not using ACEIs/ARBs during the 6-month post-intervention period. Patients who disenrolled from the plan in 2014 or were switched to another medication commonly used for treating DM and HTN were excluded from further analysis. Descriptive statistics were conducted to assess the frequency distribution of sample demographic characteristics at baseline. Multiple linear regression was conducted to assess the intervention effect on adherence during the 6 months post-intervention using the first outcome of post-intervention PDC, adjusting for baseline PDC and other covariates. Logistic regression was performed to assess the association between medication discontinuation and other baseline characteristics using the second outcome of discontinuation. Other control variables in the models included demographics (age, sex, language), physician specialty (primary care vs. specialist), health plan (low-income subsidy vs. other), Centers for Medicare & Medicaid risk score, Charlson Comorbidity Index, and number of distinct medications. RESULTS In total, 186 hypertensive diabetic patients, nonadherent to ACEIs/ARBs (PDC < 0.8), were included in the study. Of the 186 patients, 87 received the pharmacist phone call intervention. Among these patients, forgetfulness (25.29%) and doctor issues, such as having difficulty scheduling appointments (16.79%), were the most commonly reported barriers. After excluding those who switched from ACEIs/ARBs to another medication, 157 patients were included in the logistic regression model. Of those, 131 had continued using ACEIs/ARBs and were included in the linear regression model. The mean (±SD) post-intervention PDC for the intervention group was 0.58 (±0.26) and for the control group 0.29 (±0.17). Intervention was a significant predictor of better adherence in the linear regression model after adjusting all the other baseline covariates (β = 0.3182, 95% CI = 0.19-0.38, P < 0.001). Other covariates were not significantly associated with better adherence. In the logistic regression model (discontinuation: 26 [yes]/131 [no]) for predicting medication discontinuation, patients who received intervention were more likely to continue using ACEIs/ARBs (OR = 3.56, 95% CI = 1.06-11.86), and those with a higher comorbidity index were less likely to continue using them (OR = 0.72, 95% CI = 0.53-0.99). CONCLUSIONS The brief pharmacist telephone intervention resulted in significantly better PDCs during the 6 months following the intervention as well as lower discontinuation rates among a group of nonadherent patients with comorbid HTN and DM. The overall PDC rates in both the intervention and control groups were still lower than the recommended 80%. Improving adherence to clinically meaningful values may require more than a brief pharmacist phone call. Incorporating motivational interviewing techniques with follow-up calls to address adherence barriers may be more influential in forming sustainable behavioral change and enhancing medication adherence.
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Affiliation(s)
- Susan M Abughosh
- 1 Assistant Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Xin Wang
- 2 Graduate Student, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Omar Serna
- 3 Clinical Operations Director, Cigna-HealthSpring, Houston, Texas
| | - Chris Henges
- 4 Pharmacy Resident, Cigna-HealthSpring, Houston, Texas
| | - Santhi Masilamani
- 5 Clinical Assistant Professor, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Ekere James Essien
- 6 Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Nancy Chung
- 5 Clinical Assistant Professor, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Marc Fleming
- 1 Assistant Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
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Mantarro S, Capogrosso-Sansone A, Tuccori M, Blandizzi C, Montagnani S, Convertino I, Antonioli L, Fornai M, Cricelli I, Pecchioli S, Cricelli C, Lapi F. Allopurinol adherence among patients with gout: an Italian general practice database study. Int J Clin Pract 2015; 69:757-65. [PMID: 25683693 DOI: 10.1111/ijcp.12604] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Allopurinol is used as long-term therapy to reduce the occurrence of gout flares. This study estimated the impact of patient adherence to allopurinol on hyperuricaemia (serum uric acid levels, sUA > 6 mg/dl) and the identification of non-adherence predictors. METHODS The Italian Health Search-CSD Longitudinal Patient Database was accessed to identify outpatients aged ≥ 18 years with gout and prescribed with allopurinol during the years 2002-2011. Patients with a proportion of days covered ≥ 80% were considered adherent to allopurinol. Data on sUA levels over the first year of therapy were categorised in three time-windows (30-89; 90-149; 150-365 days). Logistic regressions were used to estimate the association between adherence and hyperuricaemia, as well as non-adherence predictors. RESULTS A total of 3727 patients were included. In the interval 0-29 days, the proportion of patients adherent to allopurinol was 45.9%, while up to 89, 149 and 365 days the percentages were 16.7%, 10.0% and 3.2%, respectively. The proportions of hyperuricaemic patients for each time-window were 43.1%, 42.4%, 32.6% and 59.0%, 64.0%, 66.4% among adherent and non-adherent patients, respectively. In the multivariable analysis, adherence was associated with a significant lower risk of hyperuricaemia. The adjusted ORs were 0.49 (95% CI: 0.33-0.73), 0.40 (95% CI: 0.24-0.67) and 0.23 (95% CI: 0.15-0.34) for the first, second and third time-window, respectively. Patients with hypertension (adjusted OR = 0.64, 95% CI: 0.42-0.99) and history of gout flares (adjusted OR = 0.55, 95% CI: 0.32-0.95) were significantly adherent to allopurinol. CONCLUSIONS Adherence monitoring in patients with gout is pivotal to ensure the effectiveness of therapy. To gain a better patient adherence, the communication between physicians and patients should be improved.
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Affiliation(s)
- S Mantarro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Capogrosso-Sansone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Tuccori
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - C Blandizzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - S Montagnani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Convertino
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - L Antonioli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Fornai
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners, Florence, Italy
| | - S Pecchioli
- Health Search, Italian College of General Practitioners, Florence, Italy
| | - C Cricelli
- Italian College of General Practitioners, Florence, Italy
| | - F Lapi
- Health Search, Italian College of General Practitioners, Florence, Italy
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22
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Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, Bodenheimer T, Thom DH. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med 2015; 13:130-8. [PMID: 25755034 PMCID: PMC4369595 DOI: 10.1370/afm.1768] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care. METHODS We conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California. The primary outcome was a composite measure of being at or below goal at 12 months for at least 1 of 3 uncontrolled conditions at baseline as defined by hemoglobin A1c, systolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Secondary outcomes were meeting all 3 goals and meeting individual goals. Data were analyzed using χ(2) tests and linear regression models. RESULTS Participants in the coaching arm were more likely to achieve both the primary composite measure of 1 of the clinical goals (46.4% vs 34.3%, P = .02) and the secondary composite measure of reaching all clinical goals (34.0% vs 24.7%, P = .05). Almost twice as many coached patients achieved the hemoglobin A1c goal (48.6% vs 27.6%, P = .01). At the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (41.8% vs 25.4%, P = .04). The proportion of patients meeting the systolic blood pressure goal did not differ significantly. CONCLUSIONS Medical assistants serving as in-clinic health coaches improved control of hemoglobin A1c and LDL levels, but not blood pressure, compared with usual care. Our results highlight the need to understand the relationship between patients' clinical conditions, interventions, and the contextual features of implementation.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Ellen H Chen
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California Silver Avenue Family Health Center, San Francisco Department of Public Health, San Francisco, California
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Denise DeVore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Camille Prado
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - David H Thom
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
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23
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Gastfriend DR. A pharmaceutical industry perspective on the economics of treatments for alcohol and opioid use disorders. Ann N Y Acad Sci 2014; 1327:112-30. [PMID: 25236185 PMCID: PMC4206699 DOI: 10.1111/nyas.12538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Individuals with alcohol and/or drug use disorders often fail to receive care, or evidence-based care, yet the literature shows health economic benefits. Comparative effectiveness research is emerging that examines approved approaches in terms of real, total healthcare cost/utilization. Comprehensive retrospective insurance claims analyses are few but tend to be nationally distributed and large. The emerging pattern is that, while treatment in general is cost effective, specific therapeutics can yield different health economic outcomes. Cost/utilization data consistently show greater savings with pharmacotherapies (despite their costs) versus psychosocial treatment alone. All FDA-approved addiction pharmacotherapies (oral naltrexone, extended-release naltrexone, acamprosate, disulfiram, buprenorphine, buprenorphine/naloxone, and methadone) are intended for use in conjunction with psychosocial management, not as stand-alone therapeutics; hence, pharmacotherapy costs must offer benefits in addition to abstinence alone or psychological therapy. Patient persistence is problematic, and (despite its cost) extended-release pharmacotherapy may be associated with lower or no greater total healthcare cost, mostly due to reduced hospitalization. The reviewed studies use rigorous case-mix adjustment to balance treatment cohorts but lack the randomization that clinical trials use to protect against confounding. Unlike trials, however, these studies can offer generalizability to diverse populations, providers, and payment models--and are of particular salience to payers.
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Hartung DM, McCarty D, Fu R, Wiest K, Chalk M, Gastfriend DR. Extended-release naltrexone for alcohol and opioid dependence: a meta-analysis of healthcare utilization studies. J Subst Abuse Treat 2014; 47:113-21. [PMID: 24854219 PMCID: PMC4110954 DOI: 10.1016/j.jsat.2014.03.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022]
Abstract
Through improved adherence, once-monthly injectable extended-release naltrexone (XR-NTX) may provide an advantage over other oral agents approved for alcohol and opioid dependence treatment. The objective of this study was to evaluate cost and utilization outcomes between XR-NTX and other pharmacotherapies for treatment of alcohol and opioid dependence. Published studies were identified through comprehensive search of two electronic databases. Studies were included if they compared XR-NTX to other approved medicines and reported economic and healthcare utilization outcomes in patients with opioid or alcohol dependence. We identified five observational studies comparing 1,565 patients using XR-NTX to other therapies over 6 months. Alcohol dependent XR-NTX patients had longer medication refill persistence versus acamprosate and oral naltrexone. Healthcare utilization and costs was generally lower or as low for XR-NTX-treated patients relative to other alcohol dependence agents. Opioid dependent XR-NTX patients had lower inpatient substance abuse-related utilization versus other agents and $8170 lower total cost versus methadone.
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Affiliation(s)
- Daniel M Hartung
- Oregon State University/Oregon Health & Science University College of Pharmacy, 3303 SW Bond Avenue, CH12C, Portland OR 97239.
| | - Dennis McCarty
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Rongwei Fu
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | | | - Mady Chalk
- Treatment Research Institute, Public Ledger Building, Philadelphia, PA 19106
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25
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Jeevanjee S, Penko J, Guzman D, Miaskowski C, Bangsberg DR, Kushel MB. Opioid analgesic misuse is associated with incomplete antiretroviral adherence in a cohort of HIV-infected indigent adults in San Francisco. AIDS Behav 2014; 18:1352-8. [PMID: 24077929 DOI: 10.1007/s10461-013-0619-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is little or no data examining the association between either pain or the use or misuse of opioid analgesic with adherence to antiretroviral medications (ARVs) among HIV-infected adults. We interviewed a community-based cohort of HIV-infected indigent adults prescribed antiretroviral medications (ARVs) quarterly to examine the association between (1) pain, (2) receipt of opioid analgesics, and (3) opioid analgesic misuse with self-reported ARV adherence. Of 281 participants, most (82.5 %) reported severe or moderate pain, half (52.4 %) received a prescription for opioids, and one quarter (24.6 %) misused opioid analgesics. Most (71.9 %) reported >90 % ARV adherence. In a GEE model, neither pain (unadjusted OR 1.14, CI 0.90–1.45) nor prescription of opioid analgesics (unadjusted OR 1.11, CI 0.84–1.49) were significantly associated with ARV adherence. Misuse of opioid analgesics was associated with incomplete adherence (AOR 1.42, CI 1.09–1.86). Individuals who misuse opioid analgesics, like those who use illicit substances, may have difficulty adhering to medication regimens.
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26
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Shin S, Song H, Oh SK, Choi KE, Kim H, Jang S. Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients. Hypertens Res 2013; 36:1000-5. [PMID: 23966057 DOI: 10.1038/hr.2013.85] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 04/02/2013] [Accepted: 04/18/2013] [Indexed: 11/09/2022]
Abstract
Antihypertensive medication treatment is one effective management strategy to prevent cardiovascular disease (CVD) and mortality. However, little research has been conducted on the rates of antihypertensive medication adherence and the effect of antihypertensive medication adherence on health outcomes in South Korea. We searched the Korean National Health Insurance Claims Database for records from 2003 to 2007. Patients in this study were 18 years of age or older and they were diagnosed with hypertension and newly prescribed antihypertensive medication in 2003. Adherence to antihypertensive medication was estimated as the medication possession ratio (MPR). Multivariate Cox regression was used to evaluate the association between medication adherence and adverse health outcomes after adjusting for patient demographics and clinical characteristics. Our study population consisted of 40,408 patients with a mean age of 51 years. Among the patients, 50.3% were men, 4.0% had Medicaid health insurance, 17.8% had diabetes, 20.9% had dyslipidemia and 42.4% were adherent (MPR ≥ 80%). Nonadherent patients (MPR<80%) were younger and more likely to have Medicaid health insurance; they had lower rates of diabetes and dyslipidemia compared with adherent patients. In the Cox multivariate analysis, nonadherence increased the risk of all adverse health outcomes, including all-cause mortality and hospitalization for CVD (hazard ratio: 1.57, confidence interval: 1.40-1.76). In conclusion, our study indicates that medication adherence is important for reducing hospitalization due to CVD and mortality.
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Affiliation(s)
- Sukyoun Shin
- 1] Health Insurance Review and Assessment Service, Seoul, Republic of Korea [2] Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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27
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Willard-Grace R, DeVore D, Chen EH, Hessler D, Bodenheimer T, Thom DH. The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population. BMC FAMILY PRACTICE 2013; 14:27. [PMID: 23433349 PMCID: PMC3616979 DOI: 10.1186/1471-2296-14-27] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/08/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant health coaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the medical assistant coach model include lack of clinician buy-in and the absence of a business model that will make medical assistant health coaching sustainable. This study will add to the evidence base by determining the effectiveness of health coaching by medical assistants on clinical outcomes and patient self-management, by assessing the impact of health coaching on the clinician experience, and by examining the costs and potential savings of health coaching. METHODS/DESIGN This randomized controlled trial will evaluate the effectiveness of clinic-based medical assistant health coaches to improve clinical outcomes and self-management skills among low-income patients with uncontrolled type 2 diabetes, hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary care clinics have been enrolled and randomized to receive a health coach (n = 224) or usual care (n = 217). Patients participating in the health coaching group will receive coaching for 12 months from medical assistants trained as health coaches. The primary outcome is a change in hemoglobin A1c, systolic blood pressure, or LDL cholesterol among patients with uncontrolled diabetes, hypertension and hyperlipidemia, respectively. Self-management behaviors, perceptions of the health care team and clinician, BMI, and chronic disease self-efficacy will be measured at baseline and after 12 months. Clinician experience is being assessed through surveys and qualitative interviews. Cost and utilization data will be analyzed through cost-predictive models. DISCUSSION Medical assistants are an untapped resource to provide self-management support for patients with uncontrolled chronic disease. Having successfully completed recruitment, this study is uniquely poised to assess the effectiveness of the medical assistant health coaching model, to describe barriers and facilitators to implementation, and to develop a business case for sustainability. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT-01220336.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Denise DeVore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ellen H Chen
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, Silver Avenue Family Health Center, San Francisco, CA, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - David H Thom
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
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