Not Getting to Goal: The Clinical Costs of Noncompliance

Ansell, Benjamin J.

doi:10.18553/jmcp.2008.14.s6-b.9

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…[17][18][19] This study examined the relationship between readily accessible beneficiary characteristics and medication adherence to antidiabetic, antihypertensive, and antilipidemic medications. While extensive research has been conducted to identify factors (Figure 2).…”

Section: ■■ Discussionmentioning

confidence: 99%

Geographic Variation in Medication Adherence in Commercial and Medicare Part D Populations

Couto

Panchal²,

Lal³

et al. 2014

JMCP

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BACKGROUND: Previous literature has emphasized the importance of cost sharing, health literacy, socioeconomic status, cognitive function, disease burden, and polypharmacy as some of the determinants of medication adherence. Little research has been published examining disparities in adherence rates when comparing different regions of the United States.OBJECTIVE: To examine the impact of geography, socioeconomic status, and other demographic variables on medication adherence rates in a large national sample of Medicare Part D and commercially insured beneficiaries.METHODS: This study focused on users of oral antidiabetic, antihypertensive, and/or antilipidemic medications. Beneficiaries who had at least 2 antidiabetic, antihypertensive, or antilipidemic prescription fills in 2010, 2011, or 2012 and who were enrolled in a large commercial or Medicare Part D prescription drug plan for at least 80% of one of these years (9.6 months) were included in this study. Results were stratified by year and by benefit type. Logistic regression was used to test for the adherence differences among the 9 U.S. regions as defined by the U.S. Census Bureau. Additional variables included in the model to control for population differences were age, gender, socioeconomic status, and yearly out-of-pocket medication expenses.RESULTS: After meeting all inclusion and exclusion criteria, 379,533 beneficiaries were in the 2012 Medicare cohort, and 659,553 beneficiaries were in the 2012 commercial cohort. New England was statistically the most adherent geographic region in both cohorts (Medicare odds ratio [OR] = 1.512, CI = 1.399-1.635); commercial OR = 1.193, CI = 1.109-1.284). Younger age beneficiaries, lower income beneficiaries, and females were less adherent in both groups.CONCLUSIONS: In the commercial and Medicare populations, geography, socioeconomic status, age, and gender all impact the likelihood of a beneficiary being adherent to chronic medications for hypertension, diabetes, and hyperlipidemia. While this study does not elucidate the specific factors (i.e., health literacy, disease severity) driving geographic and other differences in medication adherence observed between groups, it does highlight the limitations of quality metrics and wellness initiatives that assume relative homogeneity in beneficiary characteristics across the United States.

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Section: ■■ Discussionmentioning

confidence: 99%

Geographic Variation in Medication Adherence in Commercial and Medicare Part D Populations

Couto

Panchal²,

Lal³

et al. 2014

JMCP

View full text Add to dashboard Cite

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“…Other studies have shown a failure to titrate medications, such as statins, to effective doses in patients at risk of complications. 41,42 Some authors who stress the importance of using more aggressive therapy, such as higher doses or introducing combination therapy to get patients to goal, have described "clinical inertia," a failure of health care providers to initiate or intensify therapy when indicated. 43,44 Even though most work conducted within pharmacy has focused on adverse drug effects, drug interactions, duplicate therapy, and compliance, our data suggest that the major problem related to medications can be attributed to underuse of potentially efficacious drug therapy.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System

Oliveira¹,

Brummel²,

Miller³

2010

JMCP

294

321

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BACKGROUND: Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006.

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“…While greater medication regimen complexity may be linked with poorer adherence (Coleman et al, 2012a, b; Dunbar-Jacob et al, 2003), the magnitude of this effect may be greater in individuals with depressive symptoms (Ansell, 2008). For individuals who are cognitively intact, motivated to adhere, and are mentally well, medication regimen complexity may not dramatically affect adherence.…”

Section: Introductionmentioning

confidence: 99%

Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

et al. 2017

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Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20–50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p <.05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.

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Not Getting to Goal: The Clinical Costs of Noncompliance

Cited by 19 publications

References 25 publications

Geographic Variation in Medication Adherence in Commercial and Medicare Part D Populations

Geographic Variation in Medication Adherence in Commercial and Medicare Part D Populations

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System

Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

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