Geography and patient history in long-term lipid lowering medication adherence for primary prevention of cardiovascular disease

Hu, Feiyu; Warren, Jim; Exeter, Daniel

doi:10.1016/j.sste.2018.12.001

Cited by 3 publications

(5 citation statements)

References 49 publications

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“…Our finding that younger patients (30 to 54 years) had lower medication adherence than middle age patients (55 to 64 years) were not surprising, as this has been found in primary prevention in New Zealand, Australia and the USA . Despite reports that patients aged 35 to 54 years had significantly lower statin maintenance than patients aged 55 to 64 years following acute coronary syndromes, we did not observe significant differences among age groups in the adjusted GEE model for the 720 days following the first CVD hospitalization.…”

Section: Discussioncontrasting

confidence: 50%

“…Studies on medication adherence in primary and secondary prevention have investigated association with patient demographic factors, lifestyle and psychosocial factors, geographical location, medication history and physician‐patient communication . In addition, a patient may have different medication adherence before and after events of various types.…”

Section: Introductionmentioning

confidence: 99%

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Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

Warren

Exeter

2019

Pharmacoepidemiology and Drug

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Purpose:We analysed lipid-lowering medication adherence before and after the first hospitalization for cardiovascular disease (CVD) to explore the influence hospitalization has on patient medication adherence. Methods:We extracted a sub-cohort for analysis from 313,207 patients who had primary CVD risk assessment. Adherence was assessed as proportion of days covered (PDC) ≥ 80% based on community dispensing records. Adherence in the 4 quarters (360 days) before the first CVD hospitalization and 8 quarters (720 days) after hospital discharge was assessed for each individual in the sub-cohort. An interrupted time series design using generalized estimating equations was applied to compare the differences of population-level medication adherence rates before and after the first CVD hospitalization. Results: Overall, a significant improvement in medication adherence rate from before to after the hospitalization was observed (odds ratio (OR) 2.49 [1.74-3.57]) among the 946 patients included in the analysis. Patients having diabetes history had a higher OR of adherence before the hospitalization than patients without diabetes (1.50 [1.03-2.22]) but no significant difference after the hospitalization (OR 1.13 [0.89-1.43]). Before the first hospitalization, we observed that quarterly medication adherence rate was steady at around 55% (OR 0.97 [0.93-1.01), whereas the trend in adherence over the post-hospitalization period decreased significantly per quarter (OR 0.97 [0.94-0.99]).Conclusions: Patients were more likely to adhere to lipid-lowering therapy after experiencing a first CVD hospitalization. The change in medication adherence rate is consistent with patients having heightened perception of disease severity following the hospitalization.

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Section: Discussioncontrasting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

Warren

Exeter

2019

Pharmacoepidemiology and Drug

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“…Previous studies have shown that the initial refill history has the potential to improve subsequent medication adherence prediction for new therapy users 40,48 and past refill history was suggested as a significant factor for medication adherence prediction in primary prevention. 105 Our BRT, SVM, and ANN models using both forward and backward variable selection processes, demonstrated that variables related to past adherence behavior (e.g., past refill history, days between the latest prehospitalization dispensing date, and the hospital admission date) improved the prediction performance. These findings suggest that past refill history should be considered in primary and secondary prevention of CVD.…”

Section: Methods Of Information In Medicinementioning

confidence: 92%

Predicting Lipid-Lowering Medication Persistence after the First Cardiovascular Disease Hospitalization

Warren

Exeter

2020

Methods Inf Med

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Objectives This study analyzed patient factors in medication persistence after discharge from the first hospitalization for cardiovascular disease (CVD) with the aim of predicting persistence to lipid-lowering therapy for 1 to 2 years. Methods A subcohort having a first CVD hospitalization was selected from 313,207 patients for proportional hazard model analysis. Logistic regression, support vector machine, artificial neural networks, and boosted regression tree (BRT) models were used to predict 1- and 2-year medication persistence. Results Proportional hazard modeling found significant association of persistence with age, diabetes history, complication and comorbidity level, days stayed in hospital, CVD diagnosis type, in-patient procedures, and being new to therapy. BRT had the best predictive performance with c-statistic of 0.811 (0.799–0.824) for 1-year and 0.793 (0.772–0.814) for 2-year prediction using variables potentially available shortly after discharge. Conclusion The results suggest that development of a machine learning-based clinical decision support tool to focus improvements in secondary prevention of CVD is feasible.

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“…Most studies exploring medication adherence do not adopt geospatial techniques ( Hu et al, 2019 ). This research applied geospatial techniques to explore small area geographic variation, spatial clustering, and spatial convergence in medication adherence.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have not only described spatial variation in non-adherence but also evaluated associations with local barriers to medication adherence ( Han et al, 2020 ; Hu, Warren, & Exeter, 2019 ; Tan et al, 2017 ). The study by Han and colleagues, identified geographic variation in adherence to antihypertensive drugs amongst elderly patients with chronic kidney disease across counties of the United States.…”

Section: Introductionmentioning

confidence: 99%

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

Learnihan

Schroers

Coote

et al. 2022

SSM - Population Health

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Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.

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Geography and patient history in long-term lipid lowering medication adherence for primary prevention of cardiovascular disease

Cited by 3 publications

References 49 publications

Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

Predicting Lipid-Lowering Medication Persistence after the First Cardiovascular Disease Hospitalization

Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus

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