Impact Of Medication Adherence Research Articles

Impact of medication adherence on renal function in comorbid patients with type 2 diabetes and depression: protocol for a cohort study.

BackgroundPrevention, or slowing the progression, of diabetic nephropathy is one of the important goals in diabetes care. Although the impact of depression is a concern in patients with diabetes, it is unknown whether there is an association between adherence to hypoglycemic medication and the decline of renal function in comorbid patients with diabetes and depression. We will conduct a cohort study aimed at examining (1) depression as a predictor of renal function decline, and (2) how adherence to hypoglycemic medication relates to depression and renal function decline in patients with type 2 diabetes.Methods/DesignIn this multicenter cohort study, 550 patients with type 2 diabetes aged 20 years and older will be recruited at 20 outpatient clinics in general medicine and psychiatry. We will measure depression (Patient Health Questionnaire), medication adherence (medication possession ratio, Morisky Medication Adherence Scale, and one-item hypoglycemic medication adherence scale), and renal function (urinary albumin-creatinine ratio and estimated glomerular filtration rate) at baseline and at the 12-month follow-up. The primary endpoint is decline of renal function at 12 months. The secondary endpoints include clinical variables, quality of life, and the attitude of professionals toward depression. We will perform multivariable linear regression analysis to evaluate the effects of medication adherence on the decline of renal function in comorbid patients with type 2 diabetes and depression.DiscussionTo our knowledge, this will be the first study to examine how adherence to hypoglycemic medication relates to the decline of renal function in comorbid patients with type 2 diabetes and depression. The results of the study will have implications for practitioners of diabetes care, policy makers, and researchers for the prevention and treatment of diabetic nephropathy.Trial registrationUMIN000017513 (Registered on May 22, 2015)

Impact of Medication Adherence and Persistence on Clinical and Economic Outcomes in Patients with Type 2 Diabetes Treated with Liraglutide: A Retrospective Cohort Study

IntroductionAdherence to diabetes medication has been linked to improved glycemic levels and lower costs, but previous research on adherence has typically involved oral antidiabetic medication or insulin. This study examines how adherence and persistence to once-daily liraglutide impact glycemic control and economic outcomes in a real-world population of adult type 2 diabetes (T2D) patients.MethodsA retrospective cohort study using administrative claims data from July 2009 through September 2013. Patients aged ≥18 years with T2D treated with liraglutide were identified (index date = first liraglutide prescription). Adherence was based on the proportion of days covered (PDC); with PDC ≥0.80 classified as adherent. Non-persistent patients were those with a gap in therapy of >90 days. Lab results for glycated hemoglobin (A1C) were used to identify whether patients achieved target levels of <7.0% and ≤ 6.5%, or experienced a reduction of ≥1.0% in A1C from pre-index (baseline) to post-index (follow-up). Logistic regression was used to estimate the likelihood of achieving the A1C goals, adjusted for baseline characteristics. Diabetes-related medical, pharmacy, and total costs were modeled and estimated for the adherence and persistence cohorts.ResultsA total of 1321 patients were identified. The mean PDC was 0.59 and 34% of patients were classified as adherent, while 60% were persistent over 12 months of follow-up. Adherent and persistent patients were more likely to achieve each of the A1C goals than their non-adherent and non-persistent counterparts after adjusting for patient characteristics. Adherence and persistence were associated with higher adjusted diabetes-related pharmacy and total healthcare costs during follow-up; whereas persistent patients had significantly lower diabetes-related medical costs than non-persistent patients.ConclusionsAdherence and persistence to liraglutide are associated with improved A1C outcomes. Persistent patients showed significantly lower medical costs versus those discontinuing liraglutide. Total healthcare costs were higher for adherent and persistent cohorts driven by higher pharmacy costs.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0199-z) contains supplementary material, which is available to authorized users.

PMS69 - Impact of Medication Adherence by Using Indian Version Compliance Questionnaire Rheumatology (Cqr) and Medication Adherence Report Scale (Mars) Tools on Quality of Life of Patients With Rheumatoid Arthritis

PMS69 - Impact of Medication Adherence by Using Indian Version Compliance Questionnaire Rheumatology (Cqr) and Medication Adherence Report Scale (Mars) Tools on Quality of Life of Patients With Rheumatoid Arthritis

The impact of medication adherence on health outcomes for chronic metabolic diseases: a retrospective cohort study.

Hypertension, diabetes, and hyperlipidemia have a large influence on health outcomes dueto their chronic nature and serious complications. Medication is a key factor in preventing diseaseadvancement, and it is important to assess whether good medication adherence has any potential long-term impact on health outcomes and provides an international validation on the relationship. To evaluate the impact of good medication adherence on health outcomes of complications and hospitalizations for hypertension, hyperlipidemia, and diabetes. Patients who had had outpatient pharmacy claims for drugs for hypertension, diabetes, or hyperlipidemia were separately identified from the Korean National Health Insurance Claims Database in year 2009. A 10% random sample was respectively drawn from the three disease groups, and all claims from years 2008-2011 were extracted for the sampled subjects. Medication adherence was measured by the medication possession ratio (MPR) during the 12-month after the index date, the initial date from when medication was counted, with poor adherence as <80% of MPR. Health outcomes were measured both at 2 and 3 years after the index date as any occurrence of disease-related complications, disease-specific hospitalizations, and all-cause hospitalizations. Poor medication adherence was associated with a higher occurrence of disease-specific hospitalizations for hypertension patients (+10.9%, only at 2 years). The likelihood of all-cause hospitalization was higher among patients who had poor medication adherence in hypertension (+32% and +29% at 2 and 3 years), hyperlipidemia (+16% and +14% at 2 and 3 years), and diabetes (+32% and +29% at 2 and 3 years). Poor medication adherence also increased the likelihood of complications for hypertension (+14% and +7% at 2 and 3 years) and hyperlipidemia patients (+8.1% at 2 years). Targeting good medication adherence could be a valuable policy strategy to effectively manage chronic diseases to improve health outcomes.

Adherence and health care costs

Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e)-prescribing.

The impact of medication adherence on lung health outcomes in cystic fibrosis

As new medications continue to come to market to improve health in individuals with cystic fibrosis (CF), patient adherence is increasingly more important to address. Currently, adherence for pulmonary medications is approximately 50% for people with CF. There has been recent research that has demonstrated that poor adherence is linked to worse health outcomes. This review summarizes recent research on the impact of adherence on lung health and highlights future areas of research and clinical practice to address this growing need. Recent research has indicated that nonadherence is associated with increased hospitalizations and pulmonary exacerbations, lower baseline lung function, and longer length of stays. However, most of the research has been done using pharmacy refill records as an objective measure of adherence. Electronic monitoring of medications provides more detailed information about patterns of use, which can directly inform clinical care. Furthermore, there have been few published clinical trials evaluating behavioral interventions to promote adherence. Given the recent research linking adherence to lung health outcomes, there is a growing need to measure and evaluate adherence in clinical care. As new medications are approved for CF, methods to monitor adherence also need to be developed and approved. Clinicians need to continue to assess barriers to adherence to be able to individually tailor interventions to a patient's needs.

PRM9 - Impact of Medication Adherence on Health Care Cost in COPD

PRM9 - Impact of Medication Adherence on Health Care Cost in COPD

PRM8 - Impact of Medication Adherence on Health Care Cost in Asthma

PRM8 - Impact of Medication Adherence on Health Care Cost in Asthma

Impact of Medication Adherence on Health Care Utilization and Productivity: Self-Reported Data From a Cohort of Postmenopausal Women on Osteoporosis Therapy

Background Many pharmacologic agents are approved for the prevention and treatment of osteoporosis, which is common among postmenopausal women. Evidence exists relating treatment persistence to fracture risk. Less is known about treatment persistence and the use of health care service and individual productivity. Objective This study was undertaken to describe health care use and productivity loss relative to osteoporosis medication persistence using women's self-reported data from the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™), a large, longitudinal (October 2004–December 2009) osteoporosis cohort study of postmenopausal women. Methods Analyses included women on pharmacologic osteoporosis therapy (alendronate, risedronate, ibandronate, calcitonin, raloxifene, or teriparatide) who provided health care use/productivity data collected using semiannual questionnaires over 1 year of follow-up. Participant characteristics, use, and productivity metrics were summarized. Logistic regression models and generalized linear models were used to examine use, time missed from usual activities, number of days spent in bed, and lost work time relative to treatment persistence, adjusting for potential confounders. Results At entry, of the 2528 women studied (91% white, 3.1% Hispanic/Latino, 2.3% African American/black, 1.1% Asian, and 2.1% American Indian/Native Alaskan, Native Hawaiian/Pacific Islander, or other; mean age, 64.6 [range, 37–97] years), 43.1% had osteoporosis and 23.4% had a previous fracture. After adjustment, subjects who switched therapies during follow-up were more likely to have had any kind of diagnostic testing (95.2% of switchers vs 91.2% of persistent subjects and 88.9% of discontinuers, P < 0.05). Discontinuers were less likely than persistent subjects to visit their primary care physicians (92.0% vs 94.4%, P = 0.0337). Variations in the number of days spent in bed, time missed from usual activities, and work loss (n = 852 employed subjects) by treatment persistence were not significant. Conclusions Use of diagnostic testing differed significantly by osteoporosis treatment status. Compared with women who persisted with treatment, primary care provider visits were less common among those who discontinued treatment. Treatment persistence was not associated with significant differences in productivity measures.

The impact of medication adherence on relapse in the outpatient setting

The 15th Biennial Winter Workshop in Psychoses, 15–18 November 2009, Barcelona, Spain: EPIDEMIOLOGY, DIAGNOSIS AND PHENOMENOLOGY

Cost–Effectiveness of Osteoporosis Screening Followed by Treatment: The Impact of Medication Adherence

Objective To estimate the impact of medication adherence on the cost–effectiveness of mass-screening by bone densitometry followed by alendronate therapy for women diagnosed with osteoporosis. Methods A validated Markov microsimulation model with a Belgian health-care payer perspective and a lifetime horizon was used to assess the cost per quality-adjusted life year (QALY) gained of the screening/treatment strategy compared with no intervention. Real-world adherence to alendronate therapy and full adherence over 5 years were both investigated. The real-world adherence scenario employed adherence data from published observational studies, and medication adherence was divided into persistence, compliance, and primary adherence. Uncertainty was investigated using one-way and probabilistic sensitivity analyses. Results At 65 years of age, the costs per QALY gained because of the screening/treatment strategy versus no intervention are €32,008 and €16,918 in the real-world adherence and full adherence scenarios, respectively. The equivalent values are €80,836 and €40,462 at the age of 55 years, and they decrease to €10,600 and €1229 at the age of 75 years. Sensitivity analyses show that the presence of the upfront cost of case finding has a substantial role in the impact of medication adherence on cost–effectiveness. Conclusion This study indicates that nonadherence with osteoporosis medications substantially increases the incremental cost–effectiveness ratio of osteoporosis screening strategies. All aspects of medication adherence (i.e., compliance, persistence, and primary adherence) should therefore be reported and included in pharmacoeconomic analyses, and especially in the presence of the upfront cost of case finding (such as screening cost).

The ARBITER 6-HALTS Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6–HDL and LDL Treatment Strategies in Atherosclerosis): Final Results and the Impact of Medication Adherence, Dose, and Treatment Duration

This report describes the final results of the ARBITER 6-HALTS (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies in Atherosclerosis) trial. The ARBITER 6-HALTS trial was terminated early on the basis of a pre-specified interim analysis showing superiority of niacin over ezetimibe on change in carotid intima-media thickness (CIMT). After termination, an additional 107 subjects completed a close-out assessment. Patients with coronary heart disease (CHD) or CHD equivalent with low-density lipoprotein cholesterol <100 mg/dl and high-density lipoprotein cholesterol <50 mg/dl for men or 55 mg/dl for women while receiving stable statin treatment were randomly assigned to ezetimibe (10 mg/day) or extended-release niacin (target dose, 2,000 mg/day). The primary end point was change in mean CIMT, analyzed according to a last observation carried forward method. The relationships of study medication adherence, dosage, and cumulative exposure (product of adherence, dose, and time) with change in CIMT were explored. Results in 315 patients included 208 with 14-month follow-up and 107 after mean treatment of 7 +/- 3 months. Niacin (n = 154) resulted in significant reduction (regression) in mean CIMT (-0.0102 +/- 0.0026 mm; p < 0.001) and maximal CIMT (-0.0124 +/- 0.0036 mm; p = 0.001), whereas ezetimibe (n = 161) did not reduce mean CIMT (-0.0016 +/- 0.0024 mm; p = 0.88) or maximal CIMT (-0.0005 +/- 0.0029 mm; p = 0.88) compared with baseline. There was a significant difference between ezetimibe and niacin treatment groups on mean changes in CIMT, favoring niacin, for both mean CIMT (p = 0.016) and maximal CIMT (p = 0.01). Increased cumulative drug exposure was related to regression of CIMT with niacin, and progression of CIMT with ezetimibe. Niacin induces regression of CIMT and is superior to ezetimibe for patients taking statins. (Comparative Study of the Effect of Ezetimibe Versus Extended-Release Niacin on Atherosclerosis; NCT00397657).

Adherence to infliximab maintenance therapy and health care utilization and costs by Crohn’s disease patients

Studies suggest infliximab decreases hospitalization and surgery rates in Crohn'fs disease (CD). The aim of this analysis was to evaluate adherence to infliximab maintenance therapy and the impact of medication adherence on health care utilization and costs by patients with CD. Patients with CD who had at least four infliximab infusions (with the time between consecutive infusions < or =12 weeks for the first four infusions) during the first year following infliximab initiation (index date) were identified from the Integrated Health Care Information Service claims database (2002-2006). Nonadherence was defined as fewer than seven infliximab infusions in the first year. One-year health care resource utilization and costs (excluding infliximab drug and administration costs) were compared between adherent and nonadherent patients, with adjustment for baseline characteristics. A total of 571 patients with CD who were receiving infliximab maintenance therapy were identified. The infusion-based nonadherence rate was 34.3% during the first year of therapy. The multivariate analysis demonstrated that compared with adherent patients, nonadherent patients were more likely to have been hospitalized (odds ratio [OR]=2.7 [all-cause] and OR=2.5 [CD-related]; both P<0.001). Compared with infliximab-adherent patients, adjusted medical costs by nonadherent patients were 73% ($6,692) and 90% ($4,961) greater for all-cause and CD-related medical costs, respectively (both P<0.001), and adjusted hospitalization costs were 115% ($11,450) and 115% ($9,570) greater for all-cause and CD-related hospitalization costs, respectively (both P<0.001). More than one-third of patients on infliximab maintenance therapy were nonadherent to recommended maintenance. Further, nonadherence was associated with increased medical costs and a greater rate of hospitalization.

Impact de l’adhérence aux traitements médicamenteux sur le pronostic des patients coronariens

Prescribing recommended medications is associated with improved outcomes in coronary artery disease patients. Likewise, adherence to prescribed medications, which frequently appears far from optimal, is significantly correlated with improved survival in “real world” observational databases. The present article reviews currently available data on the impact of medication adherence on outcomes in patients with coronary artery disease.