Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis

Lim, Ming Tsuey; Rahman, Norazida Ab; Teh, Xin Rou; Chan, Chee Lee; Thevendran, Shantini; Hamdi, Najwa Ahmad; Lim, Ka Keat; Sivasampu, Sheamini

doi:10.1177/2040622321990264

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…Pharmacy fill adherence was skewed (baseline median PDC, 0.98 [IQR, 0.88-1.00]) and dichotomized as more than 90% PDC (adherent) or 90% or less PDC (nonadherent). 25 Self-reported adherence was dichotomized into nonadherent (score ≥2 on any item) and adherent. 21 Pill count adherence and BP were normally distributed and treated as continuous variables.…”

Section: Methodsmentioning

confidence: 99%

“…Fixed effects included time, race, study group, and study site with random effects of clinician and patient (eMethods 2 in Supplement 2). Pharmacy fill adherence was skewed (baseline median PDC, 0.98 [IQR, 0.88-1.00]) and dichotomized as more than 90% PDC (adherent) or 90% or less PDC (nonadherent) . Self-reported adherence was dichotomized into nonadherent (score ≥2 on any item) and adherent .…”

Section: Methodsmentioning

confidence: 99%

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Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication

Daugherty

Helmkamp²,

Vupputuri

et al. 2021

JAMA Netw Open

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IMPORTANCEStereotype threat, or the fear of confirming a negative stereotype about one's social group, may contribute to racial differences in adherence to medications by decreasing patient activation to manage chronic conditions. OBJECTIVE To examine whether a values affirmation writing exercise improves medication adherence and whether the effect differs by patient race. DESIGN, SETTING, AND PARTICIPANTS The Hypertension and Values trial, a patient-level, blinded randomized clinical trial, compared an intervention and a control writing exercise delivered immediately prior to a clinic appointment. Of 20 777 eligible, self-identified non-Hispanic Black and White patients with uncontrolled hypertension who were taking blood pressure (BP) medications, 3891 were approached and 960 enrolled. Block randomization by self-identified race ensured balanced randomization. Patients enrolled between February 1, 2017, and December 31, 2019, at 11 US safety-net and community primary care clinics, with outcomes assessed at 3 and 6 months. Analysis was performed on an intention-to-treat basis. INTERVENTIONS From a list of 11 values, intervention patients wrote about their most important values and control patients wrote about their least important values. MAIN OUTCOMES AND MEASURESThe primary outcome of adherence to BP medications was measured using pharmacy fill data (proportion of days covered >90%) at baseline, 3 months, and 6 months. The secondary outcome was systolic and diastolic BP. Patient activation to manage their health was also measured. RESULTSOf 960 patients, 474 (286 women [60.3%]; 256 Black patients [54.0%]; mean [SD] age, 63.4 [11.9] years) were randomly assigned to the intervention group and 486 (288 women [59.3%]; 272 Black patients [56.0%]; mean [SD] age, 62.8 [12.0] years) to the control group. Baseline medication adherence was lower (318 of 482 [66.0%] vs 331 of 412 [80.3%]) and mean (SE) BP higher among Black patients compared with White patients (systolic BP, 140.6 [18.5] vs 137.3 [17.8] mm Hg; diastolic BP, 83.9 [12.6] vs 79.7 [11.3] mm Hg). Compared with baseline, pharmacy fill adherence did not differ between intervention and control groups at 3 months (odds ratio [OR], 0.91

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication

Daugherty

Helmkamp²,

Vupputuri

et al. 2021

JAMA Netw Open

View full text Add to dashboard Cite

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“…A PDC of 80% or higher has been consistently used to consider an individual adherent to medication, while PDC of 90% or higher is considered optimal adherence. 16 Given these values, we categorized PDC as adequate (Ն80% to <90%) or optimal (Ն90%).…”

Section: Jama Network Open | Cardiologymentioning

confidence: 99%

Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention

et al. 2022

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ImportanceDepression is associated with increased risk of primary and secondary cardiovascular events. Medication adherence may play an essential role.ObjectiveTo evaluate the association of depression and 12-month adherence to guideline-directed medical therapies (eg, antiplatelet agents, β-blockers, renin-angiotensin-aldosterone system inhibitors [ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers], and statins) following percutaneous coronary intervention.Design, Setting, and ParticipantsThis retrospective cohort study included individuals who underwent percutaneous coronary intervention from January 1, 2014, to December 31, 2019. Data were collected from a large US health claims database and analyzed between February and August 2022.Main Outcomes and MeasuresProportion of days covered (PDC) for classes of guideline-directed medical therapies, with 12-month adherence categorized as adequate (PDC ≥80% to &lt;90%) or optimal (PDC ≥90%). Multivariable-adjusted regression models were used to evaluate the association of depression with adherence; models incorporated demographic characteristics, comorbid medical and psychiatric conditions, depression treatment, and guideline-directed medical therapy treatment adjustment. The hypothesis was that those with depression would have lower odds of either adequate or optimal adherence to agents essential for guideline-directed medical therapy.ResultsOf 124 443 individuals (mean [SD] age, 69.3 [10.6] years; 41 430 [33.3%] female sex; 3694 [3.0%] Asian, 12 611 [10.1%] Black, and 12 337 [9.9%] Hispanic individuals) who received percutaneous coronary interventions, 20 711 (16.6%) had a diagnosis of depression. Those with depression were significantly less likely to obtain adequate 12-month adherence to antiplatelets (odds ratio [OR], 0.80; 95% CI, 0.77-0.85), β-blockers (OR, 0.84; 95% CI, 0.80-0.88), and statins (OR, 0.88; 95% CI, 0.85-0.93) than those without depression; there was no association between depression and adherence to renin-angiotensin-aldosterone system inhibitors (OR, 0.93; 95% CI, 0.85-1.00). Those with depression had similarly decreased likelihood of optimal 12-month adherence to antiplatelets, β-blockers, and statins as well as renin-angiotensin-aldosterone system inhibitors (OR, 0.87; 95% CI, 0.82-0.94).Conclusions and RelevanceIn this cohort study, patients with depression were less likely to achieve adequate or optimal adherence to medications essential to guideline-directed medical therapies following percutaneous coronary intervention compared with those without depression. Recognition of depression may facilitate targeted interventions to address medication adherence and thereby improve secondary cardiovascular disease prevention.

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“…The impact of hydroxyurea on key clinical outcomes among children with SCA may be a function of differing levels of real‐world adherence to the medication outside of a clinical trial 14,15 . For example, although 80% adherence is generally considered the appropriate cutoff to achieve positive clinical outcomes, this cutoff has been shown to vary when considering outcomes across various disease states 16 . Therefore, our objective was to assess the relationship between levels of adherence to hydroxyurea and clinical outcomes among children and adolescents with SCA among a population of children insured in six state Medicaid plans.…”

Section: Introductionmentioning

confidence: 99%

“…to vary when considering outcomes across various disease states. 16 Therefore, our objective was to assess the relationship between levels of adherence to hydroxyurea and clinical outcomes among children and adolescents with SCA among a population of children insured in six state Medicaid plans.…”

Section: Introductionmentioning

confidence: 99%

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

Reeves

Dombkowski

Peng

et al. 2023

Pediatric Blood & Cancer

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Objective Hydroxyurea lowers the incidence of vaso‐occlusive pain crises (VOC) and acute chest syndrome (ACS) among children with sickle cell anemia (SCA). Our objective was to assess the relationship between levels of adherence to hydroxyurea and clinical outcomes among children and adolescents with SCA. Methods This retrospective cohort study included Medicaid data (2005–2012) from Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. The study population consisted of children 1–17 years old with SCA enrolled in Medicaid for 3 years. Among children that initiated hydroxyurea, the medication possession ratio (MPR) was calculated as the proportion of days covered by hydroxyurea. Six months after initiation of hydroxyurea, clinical outcomes were assessed through the end of the study period: numbers of VOC‐related inpatient admissions and emergency department visits, and encounters for ACS. Multivariable Poisson models were used to predict outcomes by MPR quartile adjusting for previous healthcare utilization, state, and age. Results Hydroxyurea was initiated by 515 children. The median MPR was 0.53 (interquartile range = 0.3–0.8). The annual median number of visits was 0.0 for ACS, 1.3 for VOC‐related emergency department, and 1.4 for VOC‐related inpatient admissions. For each outcome, the highest quartile of MPR had the lowest predicted count; this difference was significant for ACS visits when compared with the lowest quartile of MPR. Conclusion This study demonstrated a high level of adherence (>75%) was essential to achieve a lower incidence of common negative clinical outcomes. Further, moderate and severe hydroxyurea nonadherence may be more common than previously appreciated among children, emphasizing the importance of developing and testing innovative strategies to increase adherence.

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Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis

Cited by 9 publications

References 30 publications

Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication

Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication

Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

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