Early effects of scheduling gabapentin on medication adherence among epilepsy patients on gabapentin in Virginia.

Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.

In 2001, the North Carolina (NC) Medicaid program reduced the number of days prescription supply that enrollees could fill from 100 days to 34 days and increased copayments for brand-name medications. Previous work has shown that a change in these policies led to a decrease in medication adherence from 2.9 to 8.0 percentage points in specific populations with chronic conditions. Studies have also shown that days supply limits and copayment increases have heterogeneous effects based on enrollees' baseline characteristics, including baseline adherence. However, this phenomenon has not been studied in the Medicaid population. We undertook this study to assess the heterogeneous effect of the NC Medicaid policy changes in groups with varying levels of baseline adherence. To examine whether restrictions on days supply had heterogeneous effects in subgroups defined by medication adherence before the policy changes. A partial difference-in-difference-in-differences model with fixed effects was used to compare medication adherence before and after the NC Medicaid policy changes among Medicaid enrollees subject to the policy changes because of their use of long prescriptions (> 40 days) as compared with (a) NC Medicaid enrollees using short prescriptions (< 40 days) before policy adoption, as well as (b) Medicaid enrollees in Georgia restricted to a 31 days supply through the study period. Medicaid enrollees were included if they filled a prescription for 1 of the following medication classes: antihypertensives, lipid-lowering drugs, or antipsychotics. The effect of the policy changes on medication adherence, calculated using the proportion of days covered (PDC) each quarter by baseline adherence level and clinical condition group, was studied. Average adherence levels over the 18-month prechange period were used to stratify individuals into 3 baseline adherence groups: fully adherent (PDC ≥ 80%), partially adherent (50%-79%), and nonadherent (PDC ≤ 50%). Enrollees fully adherent at baseline observed a 2.0 (P = 0.001) and 1.2 (P < 0.001) percentage-point decline in adherence for the lipid-lowering drug and antihypertensive cohorts, respectively, in the period after the policy changes. The nonadherent and partially adherent cohorts in the statin group observed an increase in adherence by 1.7-2.6 (P < 0.05) percentage points in the post-index period. Adherence changes after cost containment policies have a heterogeneous effect on individuals with varying baseline adherence in the Medicaid population. Individuals fully adherent at baseline decreased adherence following policy changes, while individuals partially adherent and nonadherent at baseline either had no change or showed increases in adherence, possibly because of increased contact with pharmacists and clinicians required by shorter prescription lengths. Managed care strategies to control costs should take into consideration the heterogeneity of responses by the enrollees to these policies. Furthermore, policies that consider baseline characteristics of enrollees may be more effective in improving adherence. This study was partly funded by a grant from the Robert Wood Johnson Foundation for use in data creation. Maciejewski was supported by a Research Career Scientist Award from the Department of Veterans Affairs (RCS 10-391) and owns stock in Amgen. Farley reports consultancy fees from Daiichi Sankyo outside of the conduct of this study. The other authors report no financial or other conflicts of interest related to the subject of this article. The views expressed in this article are those of the authors and do not reflect the position or policy of the Centers for Medicare & Medicaid Services, University of North Carolina at Chapel Hill, Department of Veteran Affairs, or Duke University. Study design and concept were contributed by Amin and Domino, along with Farley and Maciejewski. Domino collected the data, and data interpretation was performed primarily by Amin, along with Domino, with assistance from Farley and Maciejewski. The manuscript was primarily written by Amin, along with Domino, and revised by all the authors.

BackgroundThe extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.MethodsThis retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications.ResultsOf the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50–<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period.ConclusionsWe surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.

Poor medication adherence is a well-known barrier to meeting therapeutic goals in diabetes mellitus (DM). We aimed to clarify the status of medication adherence and determine clinical variables significantly associated with medication adherence in Japanese patients with DM using a large claims database. Analyzed were data from 7459 patients with DM whose medical records on oral hypoglycemic agents (OHA) were available for at least 1 y (mean age 53 y, HbA1c 7.2%). Medication adherence was evaluated by the proportion of days covered (PDC); PDC &amp;lt;80% was defined as non-adherent. Multivariate logistic regression model was used to identify clinical variables significantly associated with non-adherence. The mean PDC was 80.4%, and 33.1% of patients were non-adherent. The PDC for sulfonylureas, biguanides, thiazolidines, α-glucosidase inhibitors, glinides, and DPP-4 inhibitors were 82% 82%, 79%, 79%, 73%, and 84%, respectively. The PDC for OHA was negatively correlated with HbA1c, LDL cholesterol, and triglycerides. HbA1c decreased by 0.2% with 25% increases in PDC. Logistic analysis indicated that older age and ≥3 concomitant medications were significantly associated with adherence while male sex and smoking were significantly associated with non-adherence (Figure), implying the necessity for effective strategies to improve medication adherence in patients in these categories. Disclosure Y. Yaguchi: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Kaneko: None. M. Kitazawa: None. M. Harada: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Adherence to therapy for pulmonary arterial hypertension is essential to optimize patient outcomes, but data on real-world adherence to different pulmonary arterial hypertension drug classes are limited. This retrospective database analysis evaluated relationships between adherence, hospitalization, and healthcare costs in pulmonary arterial hypertension patients treated with endothelin receptor antagonists or phosphodiesterase type-5 inhibitors. From the IQVIA Adjudicated Health Plan Database, patients with pulmonary arterial hypertension were identified based on diagnostic codes and prescriptions for endothelin receptor antagonists (ambrisentan, bosentan, macitentan) or phosphodiesterase type-5 inhibitors (sildenafil, tadalafil) approved for pulmonary arterial hypertension. Patients were assigned to the class of their most recently initiated (index) pulmonary arterial hypertension therapy between 1 January 2009 and 30 June 2015. Medication adherence was measured by proportion of days covered; patients with proportion of days covered ≥80% were considered adherent. The proportion of adherent patients was higher for endothelin receptor antagonists (571/755; 75.6%) than for phosphodiesterase type-5 inhibitors (970/1578; 61.5%; P < 0.0001). In both groups, hospitalizations declined as proportion of days covered increased. Among adherent patients, those on endothelin receptor antagonists had a significantly lower hospitalization rate than those on phosphodiesterase type-5 inhibitors (23.1% versus 28.5%, P = 0. 0218), fewer hospitalizations (mean (standard deviation) 0.4 (0.8) versus 0.5 (0.9); P = 0.02), and mean hospitalization costs during the six-month post-index ($9510 versus $15,726, P = 0.0318). Increasing adherence reduced hospitalization risk more for endothelin receptor antagonists than for phosphodiesterase type-5 inhibitors (hazard ratio 0.176 versus 0.549, P = 0.001). Rates and numbers of rehospitalizations within 30 days post-discharge were similar between groups. Mean total costs were higher with endothelin receptor antagonists than phosphodiesterase type-5 inhibitors in all patients ($91,328 versus $72,401, P = 0.0003) and in adherent patients ($88,867 versus $56,300, P < 0.0001), driven by higher drug costs.

Medication nonadherence to dual antiplatelet therapy increases major cardiovascular events. In this study, we investigated patients' post-acute coronary syndrome (ACS) medication adherence to clopidogrel and ticagrelor over a 12-month period. Furthermore, we also examined the factors that may affect medication adherence in this patient population. This study included 509 patients who were scheduled for dual antiplatelet therapy for one year following ACS (October 2018-December 2019). A proportion of days covered (PDC) method, based on a pharmacy database system, was used to determine their medication adherence. Medication adherence was defined as > 80% PDC. No difference was found between clopidogrel and ticagrelor in terms of medication adherence (68.3% vs. 64.6%, p = 0.39). Moreover, higher education levels (B = 3.24, CI: 1.17-8.9, p = 0.023) and percutaneous coronary intervention (PCI) as a revascularization option (B = 0.35, CI: 0.17-0.71, p = 0.004) predicted medication adherence independently. In this research, medication adherence was found to be similar between the clopidogrel and ticagrelor groups. It was also predicted by higher education levels and revascularization with PCI.

Introduction Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with OSA and comorbid depression may improve response to antidepressant medication therapy. At the same time, scant evidence has examined the impact of medication and PAP adherence in patients with OSA and comorbid depression. Patients that adhere to one therapy may be more likely to adhere to other therapies or healthy behaviors in a so-called “healthy user effect.” This retrospective study investigated the association between antidepressant medication adherence and PAP therapy adherence in patients with newly diagnosed OSA and comorbid depression. Methods Our data source was a national sample of administrative claims data linked to objective PAP therapy usage. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. Adherence to antidepressant medication was defined as ≥80% of proportion of days covered (PDC), and non-adherence was defined as &amp;lt; 80% PDC within a 180-day exposure window during the year prior to starting PAP therapy. Adherence to PAP therapy was categorized as consistently adherent, intermediately adherent, or not adherent based on objective usage over 2 years. Results 36,668 patients with OSA and comorbid depression were included. 27% were classified as consistently adherent, 45% intermediately adherent, and 28% non-adherent to PAP therapy. 68.6% of patients used antidepressant medication in the year prior to PAP initiation. 67.7% used a selective serotonin reuptake inhibitor, 43.8% atypical antidepressants, 32.1% serotonin and norepinephrine reuptake inhibitor, 10.7% tricyclic antidepressant, and 0.1% monoamine oxidase inhibitor. Relative to patients not adherent to antidepressant medication (22.2% consistently adherent, 43.8% intermediately adherent, 33.9% not adherent), those adherent to antidepressant medication in the year prior were also more adherent to PAP therapy over 2 years (29.2% consistently adherent, 45.2% intermediately adherent, 25.6% not adherent). Conclusion Patients that were adherent to antidepressant medication in the year prior to starting PAP therapy have slightly better adherence to PAP therapy over 2 years. In real-world studies, medication adherence may be an important confounder to adjust for when comparing patient outcomes. Support (if any)

POSB363 The Relationship between Medication Adherence and Quality of Life for Epilepsy Patients in Japan

BackgroundReliance on short-acting β-2 agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions could support optimal medication use and therefore disease control in patients with asthma; however, their use in community settings has not been determined.ObjectiveThe primary objective of this study is to investigate community implementation of the Turbu+ program designed to support asthma self-management, including adherence to budesonide and formoterol (Symbicort) Turbuhaler, a combination inhaler for both maintenance therapy or maintenance and reliever therapy. The secondary objective is to provide health care professionals with insights into how patients were using their medication in real life.MethodsPatients with physician-diagnosed asthma were prescribed budesonide and formoterol as maintenance therapy, at a dose of either 1 inhalation twice daily (1-BID) or 2 inhalations twice daily (2-BID), or as maintenance and reliever therapy (1-BID and reliever or 2-BID and reliever in a single inhaler), and they received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients’ inhaler for ≥90 days (data cutoff) securely uploaded medication use data to a smartphone app and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations per day or maintenance inhalations prescribed per day) averaged over the monitoring period. The proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test was used to compare the proportion of adherent days between patients in the maintenance regimen and patients in the maintenance and reliever regimen of a given dose.ResultsIn 661 patients, the mean (SD) number of days monitored was 217.2 (SD 109.0) days. The average medication adherence (maintenance doses taken/doses prescribed) was 70.2% (108,040/153,820) overall and was similar across the groups (1-BID: 6332/9520, 66.5%; 1‑BID and reliever: 43,578/61,360, 71.0%; 2-BID: 10,088/14,960, 67.4%; 2-BID and reliever: 48,042/67,980, 70.7%). The proportion of adherent days (prescribed maintenance doses/doses taken in a given day) was 56.6% (31,812/56,175) overall and was higher with maintenance and reliever therapy (1-BID and reliever vs 1-BID: 18,413/30,680, 60.0% vs 2510/4760, 52.7%; P<.001; 2-BID and reliever vs 2-BID: 8995/16,995, 52.9% vs 1894/3740, 50.6%; P=.02). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and reliever therapy compared with maintenance therapy alone (P=.01).ConclusionsOverall, the high medication adherence observed during the study might be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program.

One-year care pathway after acute myocardial infarction in 2018: Prescription, medical care and medication adherence, using a French health insurance reimbursement database

Cardiovascular diseases (CVDs) is a leading cause of death globally, accounting for approximately one-third of all deaths worldwide. Preventive therapy including combination therapy with aspirin, blood pressure, serum cholesterol-lowering, or diabetes medications is effective in reducing risk by as much as an estimated 80% when adherence to treatment is very high. However, among adults with CVD risk factors such as diabetes or hypertension, between 30% and 50% of medications are not taken as prescribed.1 Adherence is defined by the World Health Organization as the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed upon recommendations from a healthcare provider.2 Poor adherence decreases the effectiveness of evidence-based prevention therapies and is associated with increased morbidity and mortality.3 In addition, poor medication adherence represents a significant source of wasteful healthcare spending. An estimated $100 billion is spent annually on US healthcare services that are directly related to poor medication adherence.3 Poor adherence is pervasive and must be addressed by all members of the cardiovascular prevention team, across the care continuum. The causes of poor adherence are myriad and complex with contributing factors at the patient, provider, and health system levels. Patient barriers to adherence include multiple comorbid conditions requiring complex medication regimens, convenience factors (eg, dosing frequency), health beliefs, behavioral factors and issues with treatment of asymptomatic diseases (eg, treatment side effects), resource constraints and high out-of-pocket costs, suboptimal health literacy, and lack of involvement in the treatment decision-making process. Provider barriers include prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and poor care coordination. Health system barriers include office visit time limitations; limited access to care, prescription refills, or pharmacies; lack of team-based approaches; and inadequate health information technology. Because barriers to medication adherence are complex, solutions to improve adherence may be introduced at patient, provider, and/or healthcare system levels.4–6 Assessing Medication Adherence Assessment of medication adherence can be direct (ie, directly observed therapy, measurement of serum levels) or indirect (ie, pill count, measurement scales, pharmacy records). Measurement scales commonly used in research and practice to assess self-reported medication adherence include the Morisky Medication Adherence Scale,7 Hill-Bone Compliance to High Blood Pressure Therapy Scale,8 the Brief Medication Questionnaire,9 and the Krousel-Wood Medication Adherence Scale-4.10 Although these assessment instruments have relatively high internal validity, they may overestimate adherence because of their reliance on self-report. Electronic monitoring systems objectively assess medication adherence. An example is the Medication Event Monitoring System (Aardex, CH); microelectronics embedded in pill caps record the date and time when containers were opened and closed. Similar to the Medication Event Monitoring System is the Intelligent Drug Administration System, which records the date and hour that a drug was removed from blister packs.11 Major limitations include the inability of these systems to measure actual pill consumption and the limited practicality of their use in low-resource settings. Two measures of adherence using prescription-claims data are the proportion of days covered (PDC) and medication possession ratio. The PDC is endorsed by the Pharmacy Quality Alliance as a high-quality measure of medication adherence, and the threshold of greater than 80% produces the most clinical benefit for a given medication.12 The PDC is the ratio of the number of days the patient is covered by the medication divided by the number of days the patient is eligible to have the medication on hand. The medication possession ratio is calculated as the ratio of the number of days for which a patient has medication on hand divided by the total number of days in the observed period. Interventions and Toolkits to Improve Medication Adherence No single strategy has proven to be the panacea for improving medication adherence. Rather, a combination of interventions that address patient-, provider-, and system-level barriers is more likely to be effective. Interventions that have been demonstrated to improve medication adherence in CVD prevention are listed in Table 1, with a summary of recent evidence supporting these interventions provided hereinafter.TABLE 1: Medication Adherence Interventions in Patients With Cardiovascular DiseasesTailored Patient Education It is essential to educate patients about the importance of adhering to prescribed medications. An informed patient is better able to collaborate to establish shared goals of therapy and a plan of care. Compared with education delivered in a single session, educational interventions that incorporate follow-up sessions are generally more effective and lead to sustained behavior change.14 In Nieuwkerk et al's15 nurse-led clinical trial of 201 patients who were newly prescribed statins, an educational intervention that consisted of a "personalized risk factor passport" and was tailored to the patient's risk for CVD resulted in significant improvement in statin adherence and reduction in patient anxiety. Other interventions that have used telephone counseling delivered by nurses or trained educators have demonstrated success in reducing hemoglobin A1c levels16 and increased refill adherence.17 Meducation, an innovative health literacy tool that includes a medication calendar and customized education written at a sixth-grade reading level, improved self-reported medication adherence, although the effect was small in this pilot study.18 The authors of these studies suggest that healthcare providers who delivered tailored education on CVD risk reduction and reinforce education at an appropriate literacy level are more likely to be successful in improving cardiovascular outcomes. Fixed-Dose Combination Therapy Fixed-dose combination therapy, also known as single pill combinations, has recently been recognized as a best practice to improve hypertension control globally. The World Health Organization added fixed-dose combination antihypertensive medications to the World Health Organization Essential Medicines List in July 2019.19 A systematic review of dual combination vs monotherapy as initial therapy, including 33 trials with more than 10 000 participants, showed a 27% increase in the rate of achieving blood pressure control among patients receiving dual combination therapy.20 Providers should consider prescribing combination therapy where appropriate to reduce patient burden and improve control of cardiovascular conditions. Mobile Health Applications Mobile phones provide a patient-centered strategy for addressing medication adherence because of the ubiquitous nature of smartphones and the ability to send alerts to take medications, track doses, and provide appropriate medication instructions. A recent systematic review21 of mobile health (mhealth) applications targeting medication adherence identified 704 applications with different features. Of those, 20 applications were identified through a quality assessment focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs; these were available in English, German, Spanish, French, Japanese, Russian, and Traditional Chinese. The MediSAFE-BP trial evaluated the impact of the Medisafe mhealth application on medication adherence and blood pressure control. The study authors found a slight increase in medication adherence in the intervention group after 12 weeks (between-group difference, 0.4 points in the Morisky Medication Adherence Scale; P = .01), but there was no corresponding improvement in blood pressure control.22 Although mobile apps offer promise, the evidence of meaningful impact on adherence and CVD risk factor management is limited, and mhealth applications have the downsides of consumer costs and limited trial periods. Automatic Home Medication Dispenser To address the technology gap for medication reminders especially for older adults, products such as the automatic home medication dispenser (AHMD) integrated with a smartphone application have been developed. The AHMD differs from other in-home medication dispensers because it can hold up to 90 day's supply of several medications and includes the following components to address cognitive impairment and age-related changes: counter, clock, dispensing mechanism, power source, input/output interface, locking system, transceiver and antenna, and physical indicator for alarms. Other functionalities include notifying the user of due dosage per set dosage time or due refills through audio/visual reminders and notifying the caregiver of missing dosages through calls or text messages. In a recent study,23 use of an AHMD (MedaCube) significantly increased adherence from 49% at baseline to 97% after 6 months. Although AHMD is an emergent strategy to improve medication adherence, the cost of these devices may be prohibitive in lower-income populations and low-resource settings. Incentives Incentive-based medication adherence interventions have been demonstrated to be promising in several studies. Incentives such as a significant reduction in copayment have been associated with improved medication adherence.24 However, the reduced copayment incentives may not be applicable in some low- and middle-income countries where the health systems are not insurance based. Other incentive-based interventions have been in the form of cash, vouchers, gift cards, meals and food packages, clothing, and travel reimbursements for compliance to clinic visits and medication refills, although effectiveness has been inconsistent.25 A recent scoping review26 concluded that financial incentives were the most common behavioral economic intervention and the provision of physician-patient financial incentives was more effective in improving medication adherence than the provision of financial incentives to either physicians or patients alone. Table 2 displays 4 medication adherence toolkits designed to support health professionals and educators. These toolkits offer best practices and resources for (1) assessing medication adherence, (2) improving medication adherence through the use of aids, (3) empowering patients to improve medication adherence, and (4) resolving barriers to medication adherence.TABLE 2: Medication Adherence ToolkitsConclusion Medication adherence can be assessed and improved within the context of CVD prevention in the clinic, community, and home. However, improving medication adherence requires coordination and building on evidence-based strategies in practice and policy actions in both the public and private sectors. Using care coordination strategies, patient engagement and medication management tools can significantly improve medication adherence. Improving medication adherence also requires investments in health information technology and financial incentives for patients and providers. Innovations in drug delivery systems that offer a more holistic approach to managing adherence to drug therapy may help to alleviate the burden on patients.

Orally disintegrating tablets (ODTs) dissolve rapidly in contact with saliva and have been reported to facilitate oral administration of medications in swallowing difficulties. However, their clinical benefits remain unclear because no previous studies have examined whether ODTs facilitate medication adherence and clinical outcomes in patients with post-stroke dysphagia. This study evaluated the association between ODT prescriptions and clinical benefits using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a large Japanese commercial medical and dental claims database, we identified patients aged ≥ 65 years with post-stroke dysphagia between April 2014 and March 2021. To compare 1-year outcomes of medication adherence, cardiovascular events, and aspiration pneumonia between patients taking ODTs and non-ODTs, we performed hd-PS matching. We identified 11,813 patients without ODTs and 3178 patients with ODTs. After hd-PS matching, 2246 pairs were generated. Medication adherence for 1 year, based on the proportion of days covered, was not significantly different between the non-ODT and ODT groups before (0.887 vs. 0.900, P = 0.999) and after hd-PS matching (0.889 vs. 0.902, P = 0.977). The proportion of cardiovascular events (0.898 vs. 0.893, P = 0.591) and aspiration pneumonia (0.380 vs. 0.372, P = 0.558) were also not significantly different between the groups. This study found no significant differences in medication adherence, cardiovascular diseases, or aspiration pneumonia between the non-ODT and ODT groups in patients with post-stroke dysphagia. Both groups achieved a proportion of days covered exceeding 80%. Clinicians may consider prescribing ODTs or non-ODTs based on patient preferences rather than solely on post-stroke conditions.

Medication nonadherence may reduce the effectiveness of therapies. To our knowledge, the association between medication nonadherence and mortality remains unexplored outside the context of clinical trials. A retrospective cohort study of 11 532 patients with diabetes mellitus in a managed care organization. Medication adherence was calculated as the proportion of days covered for filled prescriptions of oral hypoglycemics, antihypertensives, and statin medications. The primary outcomes of interest were all-cause hospitalization and all-cause mortality. Multivariable regression analyses were performed to assess the independent association between medication adherence and outcomes. Nonadherent patients (proportion of days covered, <80%; prevalence, 21.3%) were younger and had fewer comorbidities compared with adherent patients. During follow-up, nonadherent patients had higher glycosylated hemoglobin, systolic and diastolic blood pressure, and low-density lipoprotein cholesterol levels. In unadjusted analyses, nonadherent patients had higher all-cause hospitalization (23.2% vs 19.2%, P<.001) and higher all-cause mortality (5.9% vs 4.0%, P<.001). In multivariable analyses, medication nonadherence remained significantly associated with increased risks for all-cause hospitalization (odds ratio, 1.58; 95% confidence interval, 1.38-1.81; P<.001) and for all-cause mortality (odds ratio, 1.81; 95% confidence interval, 1.46-2.23; P<.001). The findings were consistent across patient subgroups and using different cutoffs for the proportion of days covered. Medication nonadherence is prevalent among patients with diabetes mellitus and is associated with adverse outcomes. Interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.

American Indian adults have the highest prevalence of type 2 diabetes (T2D) in any racial or ethnic group and experience high rates of comorbidities. Uncontrolled cardiometabolic risk factors-insulin resistance, resulting in impaired glucose tolerance, dyslipidemia, and hypertension-increase the risk of mortality. Mortality is significantly reduced by glucose- and lipid-lowering and antihypertensive medication adherence. Medication adherence is low among American Indian adults living in non-Indian Health Service health care settings. Virtually nothing is known about the nature and extent of medication adherence among reservation-dwelling American Indian adults who primarily receive their medications without cost from Indian Health Service or tribal facilities. Electronic health records (EHRs) offer a rich but underused data source regarding medication adherence and its potential to predict cardiometabolic control indicators (C-MCIs). With the support of the Choctaw Nation of Oklahoma (CNO), we address this oversight by using EHR data generated by this large, state-of-the-art tribal health care system to investigate C-MCIs. Our specific aims are to determine, using 2018 EHR data, the bivariate relationships between medication adherence and C-MCIs, demographics, and comorbidities and each C-MCI and demographics and comorbidities; develop machine learning models for predicting future C-MCIs from the previous year's medication adherence, demographics, comorbidities, and common laboratory tests; and identify facilitators of and barriers to medication adherence within the context of social determinants of health (SDOH), EHR-derived medication adherence, and C-MCIs. Drawing on the tribe's EHR (2018-2021) data for CNO patients with T2D, we will characterize the relationships among medication adherence (to glucose- and lipid-lowering and antihypertensive drugs) and C-MCIs (hemoglobin A1c ≤7%, low-density lipoprotein cholesterol <100 mg/dL, and systolic blood pressure <130 mm Hg); patient demographics (eg, age, sex, SDOH, and residence location); and comorbidities (eg, BMI ≥30, cardiovascular disease, and chronic kidney disease). We will also characterize the association of each C-MCI with demographics and comorbidities. Prescription and pharmacy refill data will be used to calculate the proportion of days covered with medications, a typical measure of medication adherence. Using machine learning techniques, we will develop prediction models for future (2019-2021) C-MCIs based on medication adherence, patient demographics, comorbidities, and common laboratory tests (eg, lipid panel) from the previous year. Finally, key informant interviews (N=90) will explore facilitators of and barriers to medication adherence within the context of local SDOH. Funding was obtained in early 2022. The University of Florida and CNO approved the institutional review board protocols and executed the data use agreements. Data extraction is in process. We expect to obtain results from aims 1 and 2 in 2024. Our findings will yield insights into improving medication adherence and C-MCIs among American Indian adults, consistent with CNO's State of the Nation's Health Report 2017 goal of reducing T2D and its complications. PRR1-10.2196/39193.