PCV71 Primary Nonadherence to Cholesterol Medications and Associated Health Care Outcomes

Abstract

OBJECTIVES:To evaluate primary nonadherence [PNA] to cholesterol medications and compare health care outcomes between primary adherent and nonadherent patients. METHODS: This retrospective cohort study identified all patients who were treatment-naïve to antihyperlipidemics patients with at least one new cholesterol prescription written during the period of December 1, 2009 to February 28, 2010. PNA was defined as the failure to fill a prescription within 90 days of when it was written [index date]. Patients were followed for 18 months after the index date for healthcare outcomes of low-density lipoprotein [LDL] values, cardiac/stroke events, ER visits and all-cause or cardiac/stroke-related hospitalizations. Descriptive statistics were used to compare baseline characteristics and health care outcomes between primary adherent and nonadherent patients. Cox proportional hazard models were used to estimate the hazard ratio [HR] as a measure of the relative risk of each event in the primary nonadherent in comparison to the primary adherent after controlling for patient and physician characteristics. Patients were censored at the end of the follow-up period. RESULTS: A total 17,400 patients were identified during the study period and 15% were primary nonadherent. At baseline, primary nonadherent patients were sicker than primary adherent patients with significantly higher Charlson comorbidity index values, prescription use, ER visits and hospitalizations in the prior year. LDL values decreased after the index date for both groups, but primary adherent patients had a significantly greater decrease in LDL values on average [-37.2 vs. -14.9 (pϽ0.0001)]. After adjusting for baseline covariates, the resulting HR (95%CI) was 0.83 (0.69, 0.99) for cardiac/ stroke events, 0.99 (0.91, 1.09) for ER visits, 0.87 (0.77, 0.99) for all-cause hospitalization, and 0.72 (0.44, 1.12) for CV-related hospitalization. CONCLUSIONS: Primary nonadherent patients experienced smaller decreases in LDL values, but were not found to be at increased risk for cardiac/stroke events, ER visits or hospitalization during the follow-up period.

Nonadherence in type 2 diabetes: practical considerations for interpreting the literature

“…Primary non-adherence refers to patients who receive a prescription but never actually obtain the medication. Rates of primary non-adherence for anti-diabetic therapies have been reported between 4% and 31%, even though troublesome symptoms would be expected for individuals who do not receive glucose-lowering medications 4,5,30…”

Condition Critical

“…Finally, a study by Shin et al (2012) examined primary nonadherence in 10 therapeutic drug groups in order to identify factors associated with primary nonadherence [12]. The overall primary nonadherence rate for the sample was 9.8%.…”

Assessing the relationship between pharmacy quality and healthcare cost for a commercially insured population

“…Estimates for rates of primary medication nonadherence (PMN) range from single digits to nearly 25% (Cheetham et al, 2013;Fischer et al, 2011;Fischer et al, 2014;Fischer et al, 2015;Jackson et al, 2014;Raebel et al, 2012;Shin et al, 2012). These estimates are for medications used to treat diseases including asthma, diabetes, hypertension, dyslipidemia and other conditions.…”

“…These estimates are for medications used to treat diseases including asthma, diabetes, hypertension, dyslipidemia and other conditions. Methods to evaluate PMN typically use e-prescribing data (Fischer et al, 2011;Fischer et al, 2014;Fischer et al, 2015;Jackson et al, 2014;Pharmacy Quality Alliance, 2013), but some studies have used prescribing and dispensing data from integrated care settings (Cheetham et al, 2013;Raebel et al, 2012;Shin et al, 2012). Estimates do not vary systematically over source of prescription data.…”

“…Variation does exist in the definition of what constitutes a new prescription, with studies requiring no identical or same-class prescription at either 180 days (Fischer et al, 2011;Fischer et al, 2014;Jackson et al, 2014;Raebel et al, 2012) or 365 days (Cheetham et al, 2013;Fischer et al, 2015;Shin et al, 2012) prior to an index prescription date. Studies also vary in the time window used to evaluate whether or not a prescription was picked up, with some studies using days (Raebel et al, 2012;Shin et al, 2012), others 30 days (Fischer et al, 2014;Fischer et al, 2015) and some 90 days (Cheetham et al, 2013;Jackson et al, 2014) or "never filled" (Fischer et al, 2011). The development of a standard measure for PMN with a 180 day look-back period and a 30 day definition for an unfilled prescription should increase consistency of methods used in PMN studies (Pharmacy Quality Alliance, 2013).…”