Health System Factors and Antihypertensive Adherence in a Racially and Ethnically Diverse Cohort of New Users

Adams, Alyce S.; Uratsu, Connie S.; Dyer, W. T. Thiselton; Magid, David J.; O’Connor, Patrick; Beck, Arne; Butler, Melissa G.; Ho, P. Michael; Schmittdiel, Julie A.

doi:10.1001/2013.jamainternmed.955

Cited by 47 publications

(58 citation statements)

References 38 publications

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“…30 Furthermore, poor adherence among African Americans, Asian Americans, and Hispanics with hypertension improved by reducing patient copayments, improving access to medications, and optimizing choice of therapy. 32 In the current study, parental education influenced adherence among African Americans (maternal education) and non-Hispanic whites (paternal education), identifying vulnerable subpopulations that could benefit from targeted interventions.…”

Section: Discussionmentioning

confidence: 92%

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study

Bhatia

Landier

Hageman

et al. 2014

Blood

178

205

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• Adherence rates were significantly lower in African Americans (87%) and Asian Americans (90%), as compared with non-Hispanic whites (95%).• Adherence to 6MP at ,90%was associated with a 3.9-fold increased risk of relapse in a multiracial cohort of children with ALL.Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine (6MP . Adherence rate below 90% was associated with increased relapse risk (hazard ratio, 3.9; P 5 .01). Using an adherence rate <90% to define nonadherence, 20.5% of the participants were nonadherers. We identify race-specific determinants of adherence, and define a clinically relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL. This trial was registered at www.clinicaltrials. gov as #NCT00268528. (Blood. 2014;124(15):2345-2353

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Section: Discussionmentioning

confidence: 92%

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study

Bhatia

Landier

Hageman

et al. 2014

Blood

178

205

View full text Add to dashboard Cite

show abstract

“…Conversely, the longer prescription lengths and the relative ease of access available through the use of mail-order prescriptions might have promoted adherence, as other researchers have observed. 17,18 The positive association between wellness programs, patient targeting, and mail-order prescriptions is notable, considering that all of these interventions are very low cost and easily implemented. As a result, we can surmise that adding them to VBID programs would be a particularly efficient way to improve medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence

et al. 2014

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Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4-5 percentage points. These findings can provide guidance for the structure of future VBID plans.

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“…Luckily, the ability to capture fine-grained trajectories of vascular risk factor surveillance, exposure, and treatment have emerged within the past decade, with the development of electronic medical record (EMR) databases that record each and every clinical assessment, lab result, and pharmacy interaction occurring longitudinally in tens to hundreds of thousands of health system enrollees. A few health care systems that were early adopters of EMR and invested heavily in the medical informatics technology required to characterize long time courses of exposure are now positioned to recruit participants for research studies based on decade-long trajectory information (two examples are the Veterans Affairs system (Siegel, Lopez, & Meier, 2007) and Kaiser Permanente (Adams, Uratsu, Dyer, & et al, 2013)). However, there are still a number of technical hurdles to such studies.…”

Section: Ways Forwardmentioning

confidence: 99%

Preventing Vascular Effects on Brain Injury and Cognition Late in Life: Knowns and Unknowns

Carmichael

2014

Neuropsychol Rev

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For some researchers, the relationship between prevalent cardiovascular risk factors and late-life cognitive decline is not worthy of further study. It is already known that effective treatment of vascular risk factors lowers risk of such major outcomes as stroke and heart attack, the argument goes; thus, any new information about the relationship between vascular risk factors and another major outcome - late-life cognitive decline-- is unlikely to have an impact on clinical practice. The purpose of this review is to probe the logic of this argument by focusing on what is known, and what is not known, about the relationship between vascular risk factors and late-life cognitive decline. The unknowns are substantial: in particular, there is relatively little evidence that current vascular risk factor treatment protocols are adequate to prevent late-life cognitive decline or the clinically silent brain injury that precedes it. In addition, there is relatively little understanding of which factors lead to differential vulnerability or resilience to the effects of vascular risk factors on silent brain injury. Differential effects of different classes of treatments are similarly unclear. Finally, there is limited understanding of the impact of clinically-silent neurodegenerative disease processes on cerebrovascular processes. Further study of the relationships among vascular risk factors, brain injury, and late-life cognitive decline could have a major impact on development of new vascular therapies and on clinical management of vascular risk factors, and there are promising avenues for future research in this direction.

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Health System Factors and Antihypertensive Adherence in a Racially and Ethnically Diverse Cohort of New Users

Cited by 47 publications

References 38 publications

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study

Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence

Preventing Vascular Effects on Brain Injury and Cognition Late in Life: Knowns and Unknowns

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