Association of Polypharmacy and Statin New-User Adherence in a Veterans Health Administration Population

Watanabe, Jonathan H.; Bounthavong, Mark; Chen, Timothy; Ney, John P.

doi:10.1177/1060028013502000

Cited by 15 publications

(13 citation statements)

References 55 publications

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“…This confirms earlier findings that new users were more likely adhere to statin therapy if they had more medications at baseline. 47 Interestingly, despite their higher degree of polypharmacy, women are generally less likely to adhere to statins. 48 There are prior publications reporting sex disparities in clinical symptoms at initial presentation.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Peters

Kreutzburg

Rieß

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS In 2018, women are still disadvantaged in terms of optimal pharmacological treatment for peripheral arterial occlusive disease after hospital discharge. Although presenting at older age and with more severe symptoms, women have a lower prescription prevalence of optimal pharmacological treatment, particularly with respect to lipid lowering drugs. The sex prescription gap did not narrow over time, despite an overall upward trend in prescription prevalence for both women and men. Objective: Optimal pharmacological treatment (OPT) for peripheral arterial occlusive disease (PAOD) includes prescription of lipid lowering drugs, antithrombotics, and antihypertensives to symptomatic patients affected by intermittent claudication or chronic limb threatening ischaemia. This study sought to determine sex disparities and time trends in prescription of OPT in this population (clinicaltrials.gov NCT03909022). Methods: Using data from the second largest insurance fund in Germany, BARMER, data on patients with an index admission for symptomatic PAOD between 1 January 2010 and 30 June 2018 with follow up until the end of 2018 were analysed. Sex disparities in post-discharge prescription status six months after index admission were tested and adjusted for patient and healthcare variables using bivariable tests and logistic regression analysis. Time trends in the prescription prevalence of OPT were analysed and tested. Results: There were 83 867 patients (mean age 71.9 years and 45.8% women) eligible for inclusion in the study. When compared with men, women had lower rates of prior outpatient care for PAOD (39.8% vs. 47.0%), were admitted more often with ischaemic rest pain (13.9% vs. 10.4%) and were older (74 vs. 70 y). After discharge, women had a lower rate of prescriptions for lipid lowering drugs (52.4% vs. 59.9%), while they received antihypertensive drugs more often (86.7% vs. 84.1%). We found evidence for a lower prescription prevalence of OPT in females (37.0% vs. 42.7%). Differences in patient and healthcare variables (e.g. demographics, comorbidities, prior treatment) between women and men explained 56% of this gap. The sex prescription gap did not narrow over time despite an overall upward trend in prescription prevalence for both women and men. Conclusion: Although presenting older and with more severe symptoms at the index admission for PAOD, women have a lower prescription prevalence of OPT compared with men, particularly with respect to lipid lowering drugs.

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Section: Discussionmentioning

confidence: 99%

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Peters

Kreutzburg

Rieß

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…In the main analyses, IST adherence was defined as an MPR of ≥0.8, a value commonly used to distinguish between medication adherence and nonadherence in the literature. 13 , 21 , 22 Additionally, median threshold levels were used to determine who was or was not eligible for MTM. For RTRs transplanted from 2006 to 2009, the median threshold was eight for the number of Part D drugs and three for chronic conditions.…”

Section: Methodsmentioning

confidence: 99%

“…An additional sensitivity analysis, in which adherence was indicated as MPR ≥0.9 rather than 0.8 (as 0.9 is commonly used as a secondary or alternative adherence threshold), was also conducted using median MTM eligibility threshold values. 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Medication therapy management and adherence among US renal transplant recipients

Chisholm-Burns¹,

Spivey²,

Tolley³

et al. 2016

PPA

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BackgroundMedication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients’ (RTRs) immunosuppressant therapy (IST) adherence. This study’s purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant.MethodsCross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression.ResultsIn all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02–1.26, P=0.02).ConclusionThe findings provide evidence that access to MTM services increases IST adherence among RTRs.

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“…Other studies evaluating prescription medication use in the VA have also reported higher rates than the general US population. Rose and colleagues found that in their study cohort of 39,447 Veterans, 61 percent received at least eight nonwarfarin chronic medications, while Watanabe and colleagues found a mean of 7.0 prescription medications in a cohort of 4,886 Veterans. Among US adults, there has been a statistically significant increase in overall use of prescription drugs from 1990 to 2000 (51 percent) and from 2011 to 2012 (59 percent) and polypharmacy, defined as the use of ≥5 prescription drugs, was found in 15 percent of the National Health and Nutrition Examination Survey study population in 2011–2012 .…”

Section: Discussionmentioning

confidence: 94%

Caries prevalence and associations with medications and medical comorbidities

Jurasic

Gibson

Wehler

et al. 2018

J Public Health Dent

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Objectives To use extensive electronic dental, medical, and pharmacy databases to estimate the prevalence of dental caries in a cohort of new patients during a 5‐year period (FY2010–FY2015) and determine whether medication use and medical comorbidities are associated with caries prevalence. Methods This was a retrospective analysis of existing data from the Department of Veterans Affairs (VA). The number of teeth treated due to a caries‐related diagnosis was determined and outcomes were presented as number of teeth/person and proportion of patients receiving caries‐related treatment. Logistic and negative binomial regression modeled teeth/person with caries‐related treatment; covariates included age, gender, race, ethnicity, physical and mental comorbidities, and use of prescription medications and prescription drugs with strong anticholinergic properties. Results The study population included 95,850 dentate dental patients: 92.1 percent were male, mean age of 58.7 ± 12.6 years, 73.2 percent were White/Caucasian, and 21.3 percent were Black/African American. They were taking a mean of 10.6 ± 5.9 VA prescription drug classes, 0.6 ± 0.4 drugs with strong anticholinergic properties, and had 3.6 ± 2.2 physical and 1.4 ± 1.2 mental comorbidities. On average, 2.2 teeth/person received caries‐related treatment and 58 percent of the study population received any caries‐related treatment. An increase in the rate of caries‐related treatment in Veterans was statistically significantly associated with increased prescription medication use; one or more drugs with strong anticholinergic properties and with 1+ mental comorbidities. Increased physical comorbidity was not statistically significantly associated with caries‐related treatment. Conclusions This study demonstrates a high prevalence of caries among Veteran dental patients, with an increased prevalence in those taking higher numbers of prescription medications.

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Association of Polypharmacy and Statin New-User Adherence in a Veterans Health Administration Population

Abstract: Increased medication count at baseline was associated with improved adherence for new users of statins.

Cited by 15 publications

References 55 publications

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Medication therapy management and adherence among US renal transplant recipients

Caries prevalence and associations with medications and medical comorbidities

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