Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders

Raebel, Marsha A.; Ellis, Jennifer L.; Carroll, Nikki M.; Bayliss, Elizabeth A.; McGinnis, Brandy; Schroeder, Emily B.; Shetterly, Susan; Xu, Stan; Steiner, John F.

doi:10.1007/s11606-011-1829-z

Cited by 106 publications

(156 citation statements)

References 34 publications

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“…Two studies of large populations of patients in different clinical settings found PMN rates over 20%, 16,17 and studies of PMN for patients in the Geisinger system found PMN rates of 15%-17% among patients prescribed antihypertensive and oral diabetes medications. 20,21 Our considerably lower PMN rates are similar to those seen in recent reports from other integrated health care settings, [22][23][24] suggesting perhaps the structure of the health system or the use of e-prescribing was a factor in first-fill rates. However, a key difference between these studies and ours is the use of primarily in-network pharmacies versus our use of an independent pharmacy chain.…”

Section: ■■ Discussionsupporting

confidence: 82%

“…18 Studies in integrated health care systems have found lower rates of PMN (15%-17% for antihypertensives and antidiabetic medications), but the scope of the problem is substantial even in these settings. [19][20][21][22][23][24] • Primary medication nonadherence (PMN) occurs for 15%-30% of prescriptions, so that many patients never start taking medications prescribed to treat chronic diseases.…”

mentioning

confidence: 99%

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A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

Fischer¹,

Jones²,

Wright³

et al. 2015

JMCP

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Section: ■■ Discussionsupporting

confidence: 82%

mentioning

confidence: 99%

A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

Fischer¹,

Jones²,

Wright³

et al. 2015

JMCP

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“…This also implies a slight under-ascertainment of intensification, given that~5 % of patients prescribed a new medication (i.e., the provider's plan was for intensification) are never dispensed the newly prescribed medication. 14,59,60 Second, we measured medication dispensing, not actual consumption or prescribing. As such, our measure of adherence may be inflated, and our measure of treatment intensification will miss prescriptions written but never filled.…”

Section: Discussionmentioning

confidence: 99%

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

et al. 2015

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BACKGROUND: Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. METHODS: We identified three cohorts of black and white patients treated with oral medications and who had poor risk factor control at baseline (2009): those with glycated hemoglobin (HbA1c) >8 % (n=37,873), low-density lipoprotein cholesterol (LDL-C) >100 mg/dl (n=27,954), and systolic blood pressure (SBP) >130 mm Hg (n=63,641). Subjects included insured adults with diabetes who were receiving care in one of nine U.S. integrated health systems comprising the SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) consortium. Baseline and follow-up risk factor control, sociodemographic, and clinical characteristics were obtained from electronic health records. Pharmacydispensing data were used to estimate medication adherence (i.e., medication refill adherence [MRA]) and treatment intensification (i.e., dose increase or addition of new medication class) between baseline and follow-up. County-level income and educational attainment were estimated via geocoding. Logistic regression models were used to test the association between race and follow-up risk factor control. Models were specified with and without medication adherence to evaluate its role as a mediator. RESULTS: We observed poorer medication adherence among black patients than white patients (p < 0.01): 50.6 % of blacks versus 39.7 % of whites were not highly adherent (i.e., MRA <80 %) to HbA1c oral medication(s); 58.4 % of blacks and 46.7 % of whites were not highly adherent to lipid medication(s); and 33.4 % of blacks and 23.7 % of whites were not highly adherent to BP medication(s). Across all cardiometabolic risk factors, blacks were significantly less likely to achieve control (p<0.01): 41.5 % of blacks and 45.8 % of whites achieved HbA1c <8 %; 52.6 % of blacks and 60.8 % of whites achieved LDL-C <100; and 45.7 % of blacks and 53.6 % of whites achieved SBP <130. Adjusting for medication adherence/treatment intensification did not alter these patterns or model fit statistics. CONCLUSIONS: Medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.

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“…A study carried out by Marsha A. Raebel and others has shown that in patients with a newly ordered medication for hypertension, diabetes, or hyperlipidemia 7% were found primarily non-adherent. 53 Lower than 80% compliance was responsible for 1.39 times increased risk of undergoing a modification in the initially prescribed antihypertensive drug regimen. 54 Similarly a study carried out by Ho PM et al demonstrated that significantly higher rates of morbidity and hospitalization, coupled with significantly higher Hb A1C, BP, and LDL-C levels were associated with<80% adherence to their treatment regimen including oral antidiabetes agents, antihypertensive agents, and ⁄ or statin therapy compared with more adherent patients.…”

Section: Need Of Fixed Dose Combination Therapy In Treatment Of Coeximentioning

confidence: 99%

Do Fixed Dose Combinations Play an Important Role in the Management of Coexistent Type Two Diabetes Mellitus and Hypertension?

Ranpise¹,

Jamkar²,

Langote³

2015

IJPER

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The global burden of coexistent Type Two Diabetes Mellitus (TTDM) and hypertension is rising and it is emerging as a severe threat to world health and well being. This twin epidemic of coexistent TTDM and hypertension exposes patients to severe co-morbidities like cardiovascular diseases, lower limb amputations, diabetic nephropathy, diabetic retinopathy if not treated in time and with appropriate regimen. Guidelines established by various international organizations suggest multiple drug therapy for the safe and effective management of coexistent TTDM and hypertension. Such a polypharmacy with complex drug regimen leads to increased pill burden and often reflects into decreased patient compliance. This poor adherence to prescribed regimen, then gets translated into worsening of conditions and increases the hospitalization and all cause mortality to a significant extent. Use of FDCwill be one of the promising solution in the treatment of coexistent TTDM and hypertension where patients have to take 4-5 tablets on an average per day and thus show poor compliance to therapy. Use of FDC leads to the decrease in pill burden and thus helps in improving patient compliance. Along with these facts formulations of FDC also leads to simplification of complex drug regimen, synergistic effect produced by dugs in combination and reduction in cost of product. Present review describes the role of FDC in the treatment of coexistent TTDM and hypertension.

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Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders

Cited by 106 publications

References 34 publications

A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

Do Fixed Dose Combinations Play an Important Role in the Management of Coexistent Type Two Diabetes Mellitus and Hypertension?

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