Diabetes mellitus medication assistance program: relationship of effectiveness to adherence.
ABSTRACT This retrospective study examines the effect of a medication assistance program (MAP) on HbA1c levels in an uninsured, low-income, type 2 diabetes population. It also examines the degree to which improvement in HbA1c level varied with adherence to medication regimens among those patients using the MAP. The MAP was found to have a mean effect of -0.60% on HbA1c levels. However, MAP users differed in how strictly they adhered to medication regimens, as measured by number of refill opportunities taken. The MAP's effect on HbA1c varied monotonically with adherence level, with greater adherence leading to greater HbA1c improvement. Never refilling the prescription (complete nonadherence) led to no change in HbA1c, while complete adherence led to an estimated -0.88% improvement in HbA1c. Further study is needed to investigate factors related to non-adherence within medication assistance programs and the effect of such programs on other patient outcomes.
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ABSTRACT: Background Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. Purpose To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. Patients and methods A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. Results At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P<0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P<0.001] at 12 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). Conclusion The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.Patient Preference and Adherence 09/2014; 8:1185-94. DOI:10.2147/PPA.S66619 · 1.49 Impact Factor
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ABSTRACT: Medication nonadherence is known to worsen glycemic control. Few studies have examined this relationship over several years. The aim of this study was to examine the longitudinal effect of medication nonadherence on glycemic control among a large cohort of veterans. Analysis was performed on a cohort of 11 272 veterans with type 2 diabetes followed from April 1994 to May 2006. The primary outcome measures were mean glycosylated hemoglobin A1c (A1C) and proportion in poor control (A1C > 8%) over time. The main predictor was medication nonadherence based on medication possession ratio (MPR). Other covariates included sociodemographics and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models (GLMMs) were used to assess the relationship between MPR and A1C after adjusting for covariates. Mean follow-up was 5.4 years. In the linear mixed model, after adjusting for baseline A1C and other confounding variables, mean A1C decreased by 0.24 (P < 0.001) for each 10% increase in MPR (95% CI = -0.27, -0.21). In the fully adjusted GLMM, each percentage increase in MPR was associated with a 48% lower likelihood of having poor glycemic control (odds ratio = 0.52; 95% CI = 0.4, 0.6). In both continuous and dichotomized A1C analyses, average A1C showed a decreasing trend over the study period (P < 0.001). In patients with type 2 diabetes, glycemic control worsens over time in the presence of medication nonadherence. Future studies need to take into account the complexity of patient- and system-level factors affecting long-term medication adherence to improve diabetes-related outcomes.Annals of Pharmacotherapy 02/2014; 48(5). DOI:10.1177/1060028014526362 · 2.92 Impact Factor
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ABSTRACT: The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometric and biochemical parameters were measured before and after PF. The Framingham scoring method was used to estimate changes in 10-year coronary heart disease risk scores in all patients. Ninety-six of 120 patients had characteristics of MS and were randomized into two groups (G): the control group (CG: 36) and the intervention group (IG: 38). Among the MS patients, 100% were taking a glucose-lowering drug; many were also taking anti-hypertensive drugs (CG: 72%; IG: 73%), and some patients were also taking hypolipemic drugs (CG: 12.0%; IG: 14.7%). Only 20.7% of the IG patients were considered adherent to their prescribed drugs. In the CG, an increase of coronary heart disease (CHD) risk (22±2 to 26±3; p<0.05) was observed, while in the IG, there was a reduction in CHD risk (22±2 to 14±2%; p<0.01). The PC program administered to patients with MS monitored through the primary healthcare services of the Brazilian public health system improved patient health, resulting in clinical improvements and a decrease in cardiovascular risk in IG patients over a period of ten years.Brazilian Journal of Pharmaceutical Science 09/2012; 48(3):435-446. DOI:10.1590/S1984-82502012000300010 · 0.30 Impact Factor