Recommendations for Evaluating Compliance and Persistence With Hypertension Therapy Using Retrospective Data

Halpern, Michael T.; Khan, Zeba M.; Schmier, Jordana K.; Burnier, Michel; Jaime, J.; Cramer, Joyce A.; Daley, William; Gurwitz, Jerry H.; Hollenberg, Norman K.

doi:10.1161/01.hyp.0000222373.59104.3d

Cited by 163 publications

(129 citation statements)

References 46 publications

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“…The conceptual definitions for terms vary, and partly overlap, resulting in conceptual confusion, which adds to methodological weakness in the field. This problem is further compounded by a lack of congruence between conceptual definitions, operational definitions and measurements [20,[138][139][140][141][142].…”

Section: Discussionmentioning

confidence: 99%

A New Taxonomy for Describing and Defining Adherence to Medications

Vrijens

Geest

Hughes

et al. 2011

British Journal of Clinical Pharmacology

229

316

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Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications' , 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation' , 'Implementation' and 'Discontinuation' . In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.

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Section: Discussionmentioning

confidence: 99%

A New Taxonomy for Describing and Defining Adherence to Medications

Vrijens

Geest

Hughes

et al. 2011

British Journal of Clinical Pharmacology

229

316

View full text Add to dashboard Cite

show abstract

“…10,11 Table 1 lists medication classes included. Injectable and powder medications were excluded because the days supply reported may not accurately reflect true usage.…”

Section: Study Population and Data Sourcementioning

confidence: 99%

Adherence to Chronic Disease Medications among New York City Medicaid Participants

2012

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Medication adherence is critical for cardiovascular disease prevention and control. Local health departments are well positioned to address adherence issues, however relevant baseline data and a mechanism for monitoring impact of interventions are lacking. We performed a retrospective analysis using New York State Medicaid claims from 2008 to 2009 to describe rates and predictors of adherence among New York City Medicaid participants with dyslipidemia, diabetes, or hypertension. Adherence was measured using the medication possession ratio, and multivariable logistic regression was used to assess factors related to adherence. Medication regimen adherence was 63%. Greater adherence was observed in those who were older, male, and taking medications from ≥3 drug classes. Compared with whites, blacks and Hispanics were less likely to be adherent (adjusted odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.65-0.70 and adjusted OR=0.76, 95% CI: 0.73-0.78, respectively), while Asians were as likely. Medication adherence was inadequate and racial disparities were identified in NYC Medicaid participants on stable medication regimens for chronic disease. This study demonstrates a claims-based model that may be used by local health departments to monitor and evaluate efforts to improve adherence and reduce disparities.

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“…As per current recommendations and previous studies, 13,14 we chose a 120-day interval to define stoppage of medication or concomitant use of drugs, because the median duration of a prescription for an ACE inhibitor or an angiotensin-receptor blocker in Alberta is 61 days.…”

Section: Definitions Of Exposuresmentioning

confidence: 99%

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

McAlister

Zhang²,

Tonelli³

et al. 2011

Canadian Medical Association Journal

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Research CMAJ Background:The risks associated with using an angiotensin-converting-enzyme (ACE) inhibitor and an angiotensin-receptor blocker together are unclear. This study was designed to determine the safety of combination therapy with these two drugs in clinical practice. Methods:We conducted a population-based longitudinal analysis using linked administrative and laboratory data for elderly patients who were new users of an ACE inhibitor, an angiotensin-receptor blocker or a combination of both medications between May 1, 2002, and Dec. 31, 2006. We compared outcomes in patients given combination therapy versus patients given monotherapy using Cox proportional hazards analyses with adjustment for baseline characteristics.Results: Of the 32 312 new users of either medication (mean age 76.1 years, median creatinine level 92 µmol/L), 1750 (5.4%) received combination therapy. However, 1512 (86.4%) of the patients who were given combination therapy did not have trial-established indications such as heart failure or proteinuria. Renal dysfunction was more common among patients given combination therapy (5.2 [95% confidence interval (CI) 3.4 to 7.9] events per 1000 patients per month) than among patients given monotherapy (2.4 [95% CI 2.2 to 2.7] events per 1000 patients per month) (adjusted hazard ratio [HR] 2.36, 95% CI 1.51 to 3.71). Hyperkalemia was also more common among patients given combination therapy (2.5 [95% CI 1.4 to 4.3] events per 1000 patients per month) than among patients given monotherapy (0.9 [95% CI 0.8 to 1.0] events per 1000 patients per month) (adjusted HR 2.42, 95% CI 1.36 to 4.32). Most patients took combination therapy for only a short time (median three months before at least one agent was stopped).Interpretation: Combination therapy was frequently prescribed for patients without established indications and was associated with an increased risk of adverse renal outcomes when compared with monotherapy. These results mirrored data from randomized controlled trials. Abstract

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Recommendations for Evaluating Compliance and Persistence With Hypertension Therapy Using Retrospective Data

Cited by 163 publications

References 46 publications

A New Taxonomy for Describing and Defining Adherence to Medications

A New Taxonomy for Describing and Defining Adherence to Medications

Adherence to Chronic Disease Medications among New York City Medicaid Participants

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

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