Trouble Getting Started: Predictors of Primary Medication Nonadherence

Fischer, Michael; Choudhry, Niteesh K.; Brill, Gregory E.; Avorn, Jerry; Schneeweiß, Sebastian; Hutchins, David; Liberman, Joshua N.; Brennan, Troyen A.; Shrank, William H.

doi:10.1016/j.amjmed.2011.05.028

Cited by 146 publications

(151 citation statements)

References 18 publications

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“…Second, because the PDC calculation excludes patients with only one antihypertensive fill and does not include persons who are prescribed medication but never initiate treatment, it probably underestimates nonadherence. Approximately 300,000 beneficiaries in this study had only one filled prescription within a class; in general, up to one fourth of prescriptions for newly prescribed antihypertensives are never filled (23). Third, nonadherence might be overestimated among beneficiaries who switched antihypertensive classes based on their clinician's recommendation (e.g., because of side effects) or sometimes directly purchased low-priced generic antihypertensives without involvement of their prescription drug plan, but were considered nonadherent.…”

Section: Conclusion and Commentsmentioning

confidence: 99%

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Ritchey¹,

Chang²,

Powers³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

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Introduction: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. Methods: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. Conclusions and Implications for Public Health Practice: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.

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Section: Conclusion and Commentsmentioning

confidence: 99%

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Ritchey¹,

Chang²,

Powers³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

View full text Add to dashboard Cite

show abstract

“…Patients who never filled their first prescription (i.e., primary non-adherence) or who had other sources of prescription coverage (e.g., safety net programs, free samples) were also not captured in this analysis. 44 Second, we required 1-year continuous enrollment to allow for complete follow-up for adherence measures. If patients with intermittent enrollment in Medicaid programs were more likely to be poor adherers, we would underestimate the risk of clinical outcomes among those in non-adherence trajectories.…”

Section: Discussionmentioning

confidence: 99%

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

et al. 2016

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BACKGROUND: Numerous interventions are available to boost medication adherence, but the targeting of these interventions often relies on crude measures of poor adherence. Group-based trajectory models identify individuals with similar longitudinal prescription filling patterns. Identifying distinct adherence trajectories may be more useful for targeting interventions, although the association between adherence trajectories and clinical outcomes is unknown. OBJECTIVE: To examine the association between adherence trajectories for oral hypoglycemics and subsequent hospitalizations among diabetes patients. DESIGN: Retrospective cohort study. PATIENTS: A total of 16,256 Pennsylvania Medicaid enrollees, non-dually eligible for Medicare, initiating oral hypoglycemics between 2007 and 2009. MAIN MEASURES: We used group-based trajectory models to identify trajectories of oral hypoglycemics in the 12 months post-treatment initiation, using monthly proportion of days covered (PDC) as the adherence measure. Multivariable Cox proportional hazard models were used to examine the association between trajectories and time to first diabetes-related hospitalization/emergency department (ED) visits in the following year. We used the C-index to compare prediction performance between adherence trajectories and dichotomous cutpoints (annual PDC <80 vs. ≥80 %). RESULTS: The mean annual PDC was 0.58 (SD 0.32). Seven trajectories were identified: perfect adherers (9 % of the cohort), nearly perfect adherers (31.4 %), moderate adherers (21.0 %), low adherers (11.0 %), late discontinuers (6.8 %), early discontinuers (9.7 %), and non-adherers with only one fill (11.1 %). Compared to perfect adherers, trajectories of moderate adherers (HR = 1.48, 95 % CI 1.25, 1.75), low adherers (HR = 1.51, 95 % CI 1.25, 1.83), and non-adherers with only one fill (HR = 1.35, 95 % CI 1.09, 1.67) had greater risk of diabetes-related hospitalizations/ED visits. Predictive accuracy was improved using trajectories compared to dichotomized cutpoints (C-index = 0.714 vs. 0.652). CONCLUSIONS: Oral hypoglycemic treatment trajectories were highly variable in this large Medicaid cohort. Low and moderate adherers and those filling only one prescription had a modestly higher risk of hospitalizations/ED visits compared to perfect adherers. Trajectory models may be valuable in identifying specific non-adherence patterns for targeting interventions.

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“…Two studies of large populations of patients in different clinical settings found PMN rates over 20%, 16,17 and studies of PMN for patients in the Geisinger system found PMN rates of 15%-17% among patients prescribed antihypertensive and oral diabetes medications. 20,21 Our considerably lower PMN rates are similar to those seen in recent reports from other integrated health care settings, [22][23][24] suggesting perhaps the structure of the health system or the use of e-prescribing was a factor in first-fill rates.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…Among newly prescribed medications, 28% of prescriptions were never picked up, 16 which was later confirmed in a subsequent analysis on a much larger population. 17 Investigators have also found important patient and prescription-level characteristics associated with failure to pick up a prescription once bottled, including decreasing PMN with increasing age and with the presence of a pharmacy drug benefit. 18 Studies in integrated health care systems have found lower rates of PMN (15%-17% for antihypertensives and antidiabetic medications), but the scope of the problem is substantial even in these settings.…”

mentioning

confidence: 99%

A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

Fischer¹,

Jones²,

Wright³

et al. 2015

JMCP

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Trouble Getting Started: Predictors of Primary Medication Nonadherence

Cited by 146 publications

References 18 publications

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

A Randomized Telephone Intervention Trial to Reduce Primary Medication Nonadherence

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