Full Coverage for Preventive Medications after Myocardial Infarction

Choudhry, Niteesh K.; Avorn, Jerry; Glynn, Robert J.; Antman, Elliott M.; Schneeweiß, Sebastian; Toscano, Michele; Reisman, Lonny; Fernandes, Joaquim; Spettell, Claire M.; Lee, Joy; Levin, Raisa; Brennan, Troyen A.; Shrank, William H.

doi:10.1056/nejmsa1107913

Cited by 602 publications

(465 citation statements)

References 27 publications

(28 reference statements)

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“…These results are consistent with prior studies 16,23,24 and indicate a need to target specific reasons leading to medication nonadherence in this high-risk secondary-prevention population.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, the frequency and the dynamics of primary care for CVD could be different outside the VA health care system, limiting the generalizability of our findings. Lastly, our analyses did not account for medication affordability or copay, which could affect adherence 23 ; although, given the relatively universal health care coverage afforded to veterans receiving care in the VA health care system, this may not be a major determinant of adherence in the VA health care system.…”

Section: Discussionmentioning

confidence: 99%

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Is High‐Intensity Statin Therapy Associated With Lower Statin Adherence Compared With Low‐ to Moderate‐Intensity Statin Therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Virani

Woodard

Akeroyd

et al. 2014

Clinical Cardiology

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Background:The recent cholesterol guideline recommends high-intensity statins in cardiovascular disease (CVD) patients. High-intensity statins are associated with more frequent side effects. Therefore, it may be of concern that these recommendations might reduce statin adherence. Hypothesis: High-intensity statins are associated with lower adherence compared with low-to moderateintensity statins. Methods: In a national database of 972 532 CVD patients from the Veterans Health Administration, we identified patients receiving statins between October 1, 2010, and September 30, 2011. We assessed statin adherence by calculating proportion of days covered (PDC) and determined whether high-intensity statin therapy was independently associated with a lower PDC. Results: Statins were prescribed in 629 005 (64.7%). Of those, 229 437 (36.5%) received high-intensity statins. Mean PDC (0.87 vs 0.86, P < 0.0001) and patients with PDC ≥0.80 (76.3% vs 74.2%, P < 0.0001) were slightly higher for those receiving low-to moderate-intensity compared with high-intensity statins. In adjusted analyses, high-intensity statin use was associated with a significant but modest PDC reduction compared with low-to moderate-intensity statin use, whether PDC was assessed as a continuous (β-coefficient: −0.008, P < 0.0001) or categorical (PDC ≥0.80 [odds ratio: 0.94,) measure of statin adherence.Conclusions: An approach of high-intensity statin therapy will lead to a significant practice change, as the majority of CVD patients are not on high-intensity therapy. However, this change may be associated with a very modest reduction in statin adherence compared with low-to moderate-intensity therapy that is unlikely to be of clinical significance.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Is High‐Intensity Statin Therapy Associated With Lower Statin Adherence Compared With Low‐ to Moderate‐Intensity Statin Therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Virani

Woodard

Akeroyd

et al. 2014

Clinical Cardiology

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“…The systematic review by Viswanathan et al indicates that reducing out‐of‐pocket expenses and case management together with patient education and behavioral support are effective interventions 24. At the macro level, policy interventions to decrease transplant patients’ financial burden,52 including full medication coverage, have been proven effective at enhancing adherence 66…”

Section: Discussionmentioning

confidence: 99%

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

100

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Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4‐continent, 11‐country cross‐sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants—defined as any deviation in taking or timing adherence and/or dose reduction—was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS ©) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health‐related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out‐of‐pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.

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“…27 For example, the timing of the incentives-an insurance premium discount applied in the year after achieving treatment targets-may not be as effective as smaller, more frequent payments closer to when goals are achieved. 28 Covering copayment costs for medications 7,29,30 for program participation and not tied to reaching set treatment targets may also be considered as an alternative to a premium discount. However, even these types of incentives may yield only modest improvements in medication adherence 31 and presumably smaller improvements in clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Misra‐Hebert

Taksler

et al. 2016

J GEN INTERN MED

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Full Coverage for Preventive Medications after Myocardial Infarction

Cited by 602 publications

References 27 publications

Is High‐Intensity Statin Therapy Associated With Lower Statin Adherence Compared With Low‐ to Moderate‐Intensity Statin Therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Is High‐Intensity Statin Therapy Associated With Lower Statin Adherence Compared With Low‐ to Moderate‐Intensity Statin Therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

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