Variation in Medication Adherence in Heart Failure

JAMA Internal Medicine (Impact Factor: 13.12). 02/2013; 173(6):1-2. DOI: 10.1001/jamainternmed.2013.2509
Source: PubMed
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    ABSTRACT: Hospitalizations for heart failure (HF) are increasing, and HF is the primary cause of readmission for all Medicare patients. Inpatient HF mortality is poor, but most morbidity and mortality occurs after hospital discharge. Readmissions attributable to HF persist or increase over time after discharge, and past HF admissions predict both readmission and mortality. The heightened risk of readmission dissipates slowly after discharge, suggesting that any intervention should be part of a lasting care package in the outpatient setting. Interventions that apply to multiple common medical comorbidities may be more likely to reduce overall adverse events.
    Heart Failure Clinics 07/2013; 9(3):303-20. DOI:10.1016/j.hfc.2013.04.005 · 1.84 Impact Factor
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    ABSTRACT: Recent and national data on adherence to heart failure drugs are limited, particularly among the disabled and some small minority groups, such as Native Americans and Hispanics. We compare medication adherence among Medicare patients with heart failure, by disability status, race/ethnicity, and income. Observational study. US Medicare Parts A, B, and D data, 5 % random sample, 2007-2009. 149,893 elderly Medicare beneficiaries and 21,204 disabled non-elderly beneficiaries. We examined 5 % of Medicare fee-for-service beneficiaries with heart failure in 2007-2009. The main outcome was 1-year adherence to one of three therapeutic classes: β-blockers, diuretics, and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs). Adherence was defined as having prescriptions in possession for ≥ 75 % of days. Among aged beneficiaries, 1-year adherences to at least one heart failure drug were 63 %, 57 %, 53 %, 50 %, and 52 % for Whites, Asians, Hispanics, Native Americans and Blacks, respectively; among the disabled, 1-year adherence was worse for each group: 57 %, 53 %, 48 %, 44 % and 43 % respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location and health status. Patterns of adherence were similar among beneficiaries on all three therapeutic classes. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to Whites, OR = 0.61 (95 % CI 0.58-0.64) for Hispanics, OR = 0.59 (95 % CI 0.57-0.62) for Blacks and OR = 0.57 (95 % CI 0.47-0.68) for Native Americans. After the implementation of Medicare Part D, adherence to heart failure drugs remains problematic, especially among disabled and minority beneficiaries, including Native Americans, Blacks, and Hispanics. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.
    Journal of General Internal Medicine 12/2013; 29(4). DOI:10.1007/s11606-013-2692-x · 3.42 Impact Factor
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    ABSTRACT: Background: Few studies have investigated regional variation in medication-taking behaviour. The purpose of this study was to investigate whether there are regional differences in non-persistence and non-adherence to oral anti-hyperglycaemic agents in patients initiating therapy and examine if any association exists between different types of comorbidity in terms of medication-taking behaviour. Methods: The Irish Health Services Executive (HSE) pharmacy claims database was used to identify new users of metformin or sulphonylureas, aged ≥25 years, initiating therapy between June 2009 and December 2010. Non-persistence and non-adherence were examined up to 12 months post-initiation. Comorbidity was assessed using modified RxRisk and RxRisk-V indices, and classified as either concordant and/or discordant with diabetes. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for non-persistence were determined in relation to both HSE region and comorbidity type using Cox proportional hazards model, adjusting for age, sex and initial OAH prescribed. Logistic regression analysis, adjusting for these covariates, was used to determine the adjusted odds ratios (ORs) and 95% CIs for non-adherence for both HSE region and comorbidity type. Results: Results showed little overall difference between regions. The largest reduction for both non-persistence (HR 0.86, 95% CI 0.80, 0.94) and non-adherence (OR 0.83, 95% CI 0.74, 0.93) was observed in the south. Any comorbidity was associated with a reduced risk of non-persistence and non-adherence. Conclusions: Interventions to optimise medication-taking in patients with T2DM should be implemented nationally to improve the overall level of adherence and persistence, especially in patients with no comorbidity.
    Irish Journal of Medical Science 05/2014; 184(2). DOI:10.1007/s11845-014-1132-1 · 0.83 Impact Factor
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