Relationship Between Medication Adherence and Distance to Dispensing Pharmacies and Prescribers Among an Urban Medicaid Population with Diabetes Mellitus

Abstract

Study Objective To determine whether a relationship exists between medication adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and distance to dispensing pharmacies and prescribers among an urban, public aid population with diabetes mellitus. Design Retrospective cohort study using claims data. Data Source Illinois Department of Healthcare and Family Services database. Patients A total of 6532 patients aged 18–64 years with diabetes who had at least one prescription fill for an ACEI or ARB, and had continuous Medicaid coverage in the greater Chicago area in 2009. Measurements and Main Results Medication adherence, defined as proportion of days covered (PDC) ≥ 0.8, to ACEIs and ARBs and its association with distances between patients and their pharmacies and prescribers was assessed. Of the 6532 patients included in the analyses, 2930 (45%) had PDC levels ≥ 0.8. No significant differences were observed between patients who were adherent versus those who were nonadherent in distance to pharmacy (median 1.39 vs 1.35 miles, p=0.15) or distance to prescriber (median 4.39 vs 4.48 miles, p=0.80). In a multivariate regression model including age, sex, race-ethnicity, number of pharmacies, number of prescribers, distance to pharmacy, and distance to prescriber, a greater number of prescribers was associated with higher adherence (2 prescribers vs 1 prescriber: odds ratio [OR] 1.396, 95% confidence interval [CI] 1.233–1.580; ≥ 3 prescribers vs 1 prescriber: OR 2.208, 95% CI 1.787–2.727). Conclusion ACEI or ARB adherence was not associated with distances to pharmacies and prescribers.

Geosocial Factors Associated With Adherence to Statin Medications

“…The finding that geographic distance to pharmacy was not a significant predictor has been demonstrated in previous studies. 4,5 Conversely, the present study found that RI, a measure of 1 dimension of RRS, was significantly associated with adherence, where residence in more isolated areas was associated with lower adherence. Likewise, the SES measure used in the present study found that areas of lower SES had lower levels of adherence to statin drug therapy.…”

“…3 Patients may need to travel farther when there is limited access to pharmacies close to home. Generally, studies have found that the distance between home and the pharmacy is not significantly associated with medication adherence 4,5 and that patients may travel beyond their most closely located pharmacy to one they are more satisfied with. 6 A previous study by the investigators found that statin adherence varies significantly across the State of Michigan for an insured sample of patients taking statin therapy.…”

“…It is known that patients living in more racially segregated areas, as well as areas with lower income, have greater transportation problems and potentially fewer pharmacies to choose from. 4,23…”

Medical facilities in the neighborhood and incidence of sudden cardiac arrest

“…Upon further control for individual-level income, mainly null effect estimates were observed and the authors concluded that it is unlikely that neighborhood healthcare facilities have a large independent influence on cardiovascular risk [14]. A recent study looking at the distance to pharmacies and medication adherence in the greater Chicago area did not find an association between shorter distances and improved adherence [29]. Taken together, these previous studies and our findings are consistent with the possibility that, at least for our populations, neighborhood availability of medical facilities may not promote health as hypothesized.…”

Factors Affecting Rural Patients' Primary Compliance with e-Prescription: A Developing Country Perspective

“…Patel et al 23 found a positive correlation between drug adherence and physician visiting frequency, which motivated us to check whether there is any significant relationship between patients' visiting frequency of PHC and their primary compliance with the prescription. Syed et al 24 examined the relationship between medication compliance and distance to pharmacy and prescriber, which reinforced us to add one more variable to our research framework. However, in this study, we have employed a total of seven independent variables to measure their impacts and magnitudes on rural patients' primary compliance with e-prescription, which is shown as our research framework in Figure 2 .…”