Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy

Benner, Joshua S.; Tierce, Jonothan C.; Ballantyne, Christie M.; Prasad, C. Maruthi; Bullano, Michael F.; Willey, Vincent J.; Erbey, John R.; Sugano, David

doi:10.2165/00019053-200422003-00003

Cited by 98 publications

(68 citation statements)

References 28 publications

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“…19 Several methods for improving long-term medication adherence have been promoted in the literature, including early physician follow-up, as well as enrollment in cardiac rehabilitation and patient education programs. [19][20][21][22] Of note, patients with MI who undergo outpatient physician follow-up within 1 month after hospital discharge have significantly higher rates of medication use 6 months later. 23 Modest improvements in adherence were noted with the elimination of medication copayments in the MI FREEE trial 14 and in the current surgical subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

et al. 2013

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Background— Eliminating out-of-pocket costs for patients after myocardial infarction (MI) improves adherence to preventive therapies and reduces clinical events. Because adherence to medical therapy is low among patients treated with coronary artery bypass graft surgery (CABG), we evaluated the impact of providing full prescription coverage to this patient subgroup. Methods and Results— The MI Free Rx Event and Economic Evaluation (FREEE) trial randomly assigned 5855 patients with MI to full prescription coverage or usual formulary coverage for all statins, β-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers. We assessed the impact of full prescription coverage on adherence, clinical outcomes, and healthcare costs using adjusted models among the 1052 patients who underwent CABG at the index hospitalization and 4803 who did not. CABG patients were older and had more comorbid illness ( P <0.01). After MI, CABG patients were significantly more likely to receive β-blockers and statins but were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy ( P <0.01). Receiving full drug coverage increased rates of adherence to all preventative medications after CABG (all P <0.05). Full coverage was also associated with nonsignificant reductions in the rate of major vascular events or revascularization for patients treated with CABG (hazard ratio, 0.91; 95% confidence interval, 0.66–1.25) or without CABG (hazard ratio, 0.93; 95% confidence interval, 0.82–1.06), with no interaction noted ( P int =NS). After CABG, full prescription coverage significantly reduced patient out-of-pocket spending for drugs ( P =0.001) without increasing overall health expenditures ( P =NS). Conclusions— Eliminating drug copayments after MI provides consistent benefits to patients treated with or without CABG, leading to increased medication adherence, trends toward improved clinical outcomes, and reduced patient out-of-pocket expenses.

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Section: Discussionmentioning

confidence: 99%

Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

et al. 2013

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“…18 Hence, persons who have been newly prescribed medications comprise an interesting subgroup when pharmaceutical care programs are implemented. Most studies aimed at improving adherence among users of statins were hospital pharmacy-based, 7-10,14, 16 sometimes with complex interventions 10,14, 17 and mostly not focusing solely on patients initiating statin treatment.…”

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confidence: 99%

A Pharmaceutical Care Program to Improve Adherence to Statin Therapy: A Randomized Controlled Trial

et al. 2010

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Background: Despite the well-known beneficial effects of statins, many patients do not adhere to chronic medication regimens. Objective: To implement and assess the effectiveness of a community pharmacy-based pharmaceutical care program developed to improve patients' adherence to statin therapy. Methods: An open-label, prospective, randomized controlled trial was conducted at 26 community pharmacies in the Netherlands. New users of statins who were aged 18 years or older were randomly assigned to receive either usual care or a pharmacist intervention. The intervention consisted of 5 individual counseling sessions by a pharmacist during a 1-year period. During these sessions, patients received structured education about the importance of medication adherence, lipid levels were measured, and the association between adherence and lipid levels was discussed. Adherence to statin therapy was assessed as discontinuation rates 6 and 12 months after statin initiation, and as the medication possession ratio (MPR), and compared between the pharmaceutical care and usual care groups. Results: A total of 899 subjects (439 in the pharmaceutical care group and 460 in the usual care group) were evaluable for effectiveness analysis. The pharmaceutical care program resulted in a significantly lower rate of discontinuation within 6 months after initiating therapy versus usual care (HR 0.66, 95% CI 0.46 to 0.96). No significant difference between groups was found in discontinuation at 12 months (HR 0.84, 95% CI 0.65 to 1.10). Median MPR was very high (>99%) in both groups and did not differ between groups. Conclusions: These results demonstrate the feasibility and effectiveness of a community pharmacy–based pharmaceutical care program to improve medication adherence in new users of statins. Frequent counseling sessions (every 3 months) are necessary to maintain the positive effects on discontinuation. Although improvements are modest, the program can be applied easily to a larger population and have a large impact, as the interventions are relatively inexpensive and easy to implement in clinical practice.

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“…[4][5][6][7][8][9] In 4 of these studies, 4,7-9 a positive relation was observed. For example, a high level of continuity of care was associated with higher persistence with statins 8 and higher compliance with treatment with orally administered antidiabetics, 7 statins 9 and drugs used in heart failure. 4 However, 5 of these studies 4,[6][7][8][9] were limited by the fact that their design was cross-sectional.…”

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confidence: 76%

“…For example, a high level of continuity of care was associated with higher persistence with statins 8 and higher compliance with treatment with orally administered antidiabetics, 7 statins 9 and drugs used in heart failure. 4 However, 5 of these studies 4,[6][7][8][9] were limited by the fact that their design was cross-sectional. Therefore, the temporal relation between continuity of care and medication adherence could not be established.…”

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confidence: 99%

Association between interpersonal continuity of care and medication adherence in type 2 diabetes: an observational cohort study

et al. 2017

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CMAJ OPEN, 5(2) E359I nterpersonal continuity of care refers to the ongoing relationship between a patient and an individual physician. 1 There is good evidence from a systematic review that a high level of interpersonal continuity of care is associated with decreased hospital admissions and emergency department visits, and improved patient satisfaction.2 To what extent a high level of continuity of care is associated with a higher likelihood of medication adherence is less clear.2 Medication adherence consists of 2 main constructs: persistence (consistently refilling prescriptions for the prescribed length of time) and compliance (taking the drug in accordance with the prescribed dosage and schedule).3 To our knowledge, the relation between interpersonal continuity of care and medication adherence has been assessed in 6 studies. [4][5][6][7][8][9] In 4 of these studies, 4,7-9 a positive relation was observed. For example, a high level of continuity of care was associated with higher persistence with statins 8 and higher compliance with treatment with orally administered antidiabetics, 7 statins 9 and drugs used in heart failure.4 However, 5 of these studies 4,6-9 were limited by the fact that their design was cross-sectional. Therefore, the temporal relation between continuity of care and medication adherence could not be established.Patient adherence to oral antidiabetic treatment is not optimal. For example, in a study conducted in Quebec, 79% of patients were persistent with oral antidiabetic treatment 1 year after initiation of therapy; of the 79%, only 78% were compliant (obtained drug supplies for at least 80% of days during the year). Background: Prior studies have shown that, compared to patients with a low level of interpersonal continuity of care, patients with a high level of continuity of care have a lower likelihood of hospital admission and emergency department visits, and a higher likelihood of patient satisfaction. We sought to determine whether higher levels of continuity of care are associated with medication persistence and compliance among new users of oral antidiabetic treatment.

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Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy

Abstract: Early and frequent follow-up by physicians--especially lipid testing--was associated with improved adherence to lipid-lowering therapy. A randomised prospective study is needed to determine whether this relationship is causal.

Cited by 98 publications

References 28 publications

Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

A Pharmaceutical Care Program to Improve Adherence to Statin Therapy: A Randomized Controlled Trial

Association between interpersonal continuity of care and medication adherence in type 2 diabetes: an observational cohort study

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