State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication

Yang, Peter K; Ritchey, Matthew D.; Tsipas, Stavros; Loustalot, Fleetwood; Wozniak, Gregory

doi:10.5888/pcd17.190440

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…This allows us to track patients longitudinally even if they switch insurers or pharmacies. This dataset is regularly used in medical, regulatory, and policy research, as well as by commercial firms like pharmaceutical and insurance companies [e.g., 6 – 9 ]. The extract from this dataset that we received contains de-identified data on 9.4 billion prescription claims from more than 252 million patients between May, 2019 and August, 2020.…”

Section: Methodsmentioning

confidence: 99%

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

2021

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Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients’ access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient’s likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.

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Section: Methodsmentioning

confidence: 99%

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

2021

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“…32,33 Besides insurance, the regional variation in adherence can also be affected by factors like polypharmacy and complex drug regimens involving taking multiple pills at different times of the day, poor access to pharmacies especially in rural areas, and higher out-ofpocket expenses in areas with predominantly low-income populations. 34 These can be rectified by introducing better prescription practice guidelines involving generic fixed-dose drug combinations which will reduce the costs as well as the number of pills, increasing doorstep delivery of medications by switching to mail-order or online pharmacy practices. 35,36 Our results also revealed that CRMN was higher among current smokers compared to non-smokers.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting Cost-Related Medication Non-Adherence among US population with Cardiovascular Risk Factors

Gandrakota,

Ramakrishnan,

Sudireddy

et al. 2024

Preprint

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Introduction In the US, cardiovascular diseases (CVD) are the leading cause of death and disability. Cost-related non-adherence (CRMN) can have serious consequences and worsen CVD outcomes. We examined the relationship between CVD risk factors and CRMN among US adults. Methods CDC?s 2019-2021 National Health Interview Survey (NHIS) data was used to examine CRMN among adults, categorized into three groups based on reported risk factors. We used chi-square tests, logistic regression to determine factors associated with CRMN. Results Among 49,464 participants, young, unmarried individuals, females, less educated, and participants from South had higher CRMN than older, married individuals, males, and those with higher education residing in the other regions. Current smokers and those with more CVD risk factors also had a higher CRMN than former smokers and never-smokers. Conversely, those aged 65 or older, with high-income, and excellent self-rated health had lower CRMN than younger participants, low-income families, and those with poor self-health. Public insurance and Medicaid participants had lower CRMN than uninsured (OR 0.13, 95% CI, 0.04-0.45, and OR 0.24, 95% CI, 0.15-0.36). Stratified regression analysis by disease status, i.e., diabetes, hypertension, and hyperlipidemia, revealed participants with high-income had lower odds of CRMN (OR 0.38, 95% CI 0.28-0.50; OR 0.39, 95% CI, 0.28-0.58; OR 0.37, 95% CI 0.27-0.51 respectively) than those with lower incomes. Conclusion Adults under 65 with more CVD risk factors are at higher risk of CRMN. Hence, robust prescription drug coverage and targeted interventions are necessary to lower CRMN in those with CVD risk factors.

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“…Fixed‐dose combinations are evidence‐based but underutilized, comprising only 12% of all national BP medication fills in 2017, with considerably lower values in southern states where hypertension‐related CVD death rates are high. 54 Increasing adherence to these medication regimens is critical. Despite the 706.5 million BP medication prescriptions filled in the United States in 2017, only half of treated patients followed physicians’ instructions, with lower adherence among Black adults and in the South.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the 706.5 million BP medication prescriptions filled in the United States in 2017, only half of treated patients followed physicians’ instructions, with lower adherence among Black adults and in the South. 54 , 55 , 56 Finally, improved telehealth capabilities could optimize clinical care, especially in counties with limited access to care. Telehealth visits have increased during the COVID‐19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

County‐Level Trends in Hypertension‐Related Cardiovascular Disease Mortality—United States, 2000 to 2019

Vaughan

Coronado

Casper

et al. 2022

JAHA

Self Cite

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Background Amid stagnating declines in national cardiovascular disease (CVD) mortality, documenting trends in county‐level hypertension‐related CVD death rates can help activate local efforts prioritizing hypertension prevention, detection, and control. Methods and Results Using death certificate data from the National Vital Statistics System, Bayesian spatiotemporal models were used to estimate county‐level hypertension‐related CVD death rates and corresponding trends during 2000 to 2010 and 2010 to 2019 for adults aged ≥35 years overall and by age group, race or ethnicity, and sex. Among adults aged 35 to 64 years, county‐level hypertension‐related CVD death rates increased from a median of 23.2 per 100 000 in 2000 to 43.4 per 100 000 in 2019. Among adults aged ≥65 years, county‐level hypertension‐related CVD death rates increased from a median of 362.1 per 100 000 in 2000 to 430.1 per 100 000 in 2019. Increases were larger and more prevalent among adults aged 35 to 64 years than those aged ≥65 years. More than 75% of counties experienced increasing hypertension‐related CVD death rates among patients aged 35 to 64 years during 2000 to 2010 and 2010 to 2019 (76.2% [95% credible interval, 74.7–78.4] and 86.2% [95% credible interval, 84.6–87.6], respectively), compared with 48.2% (95% credible interval, 47.0–49.7) during 2000 to 2010 and 66.1% (95% credible interval, 64.9–67.1) for patients aged ≥65 years. The highest rates for both age groups were among men and Black populations. All racial and ethnic categories in both age groups experienced widespread county‐level increases. Conclusions Large, widespread county‐level increases in hypertension‐related CVD mortality sound an alarm for intensified clinical and public health actions to improve hypertension prevention, detection, and control and prevent subsequent CVD deaths in counties across the nation.

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State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication

Cited by 10 publications

References 29 publications

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

Factors affecting Cost-Related Medication Non-Adherence among US population with Cardiovascular Risk Factors

County‐Level Trends in Hypertension‐Related Cardiovascular Disease Mortality—United States, 2000 to 2019

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