Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: A retrospective cohort study (original) (raw)
Related papers
Medical Care, 2011
Background: Employer-based retiree drug benefits have long been viewed as the gold standard of drug coverage for elderly Medicare beneficiaries. The question for policy makers is whether beneficiaries enrolled in Part D plans exhibit drug utilization patterns comparable with those seen in retiree plans. Objective: To compare utilization patterns for antidiabetic agents, renin-angiotensin-aldosterone system inhibitors, and antihyperlipidemics by elderly Medicare beneficiaries with diabetes enrolled in Medicare prescription drug plans (PDPs) and retiree health plans (RHPs). Methods: A random 5% sample (N = 45,613) of elderly diabetic patients with continuous 2006 PDP enrollment was selected from Medicare files and compared with a similar sample of elderly RHP enrollees from MarketScan (N = 211,919) on any use, duration of therapy, and medication possession ratio for each drug class. Adjusted comparisons were made on samples (N = 16,859 each) using propensity score matching. Results: Drug utilization and adherence rates were high in both groups. In propensity score adjusted comparisons, prevalence rates for PDP enrollees were within 2.2% of the level of RHP enrollees for antidiabetic agents and renin-angiotensin-aldosterone system inhibitors, but differed sharply for antihyperlipidemics (61% vs. 69%; P<0.0001). There were no clinically meaningful differences between PDP and RHP enrollees in duration of therapy or medication possession ratio for any drug class. Conclusion: When otherwise similar Medicare beneficiaries with diabetes have drug coverage, the source of benefits has little effect on use and adherence with most (but not all) drugs recommended in diabetes guidelines.
Does Medication Adherence Lower Medicare Spending among Beneficiaries with Diabetes
Objective. To measure 3-year medication possession ratios (MPRs) for reninangiotensin-aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. Data Source. Medicare Current Beneficiary Survey data from 1997 to 2005. Study Design. Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. Data Collection. The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. Principal Findings. Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.$832 lower Medicare spending (SE 5 219; po.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.$285 lower Medicare costs (SE 5 114; po.05). Conclusions. Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs.
Research in Social and Administrative Pharmacy, 2013
Background: Information about the prevalence and correlates of self-reported medication nonadherence using multiple measures in older adults with chronic cardiovascular conditions is needed. Objective: To examine the prevalence and correlates of self-reported medication nonadherence among community-dwelling elders with chronic cardiovascular conditions. Methods: Participants (n ¼ 897) included members from the Health, Aging and Body Composition Study with coronary heart disease, diabetes mellitus, and/or hypertension at Year 10. Self-reported nonadherence was measured by the 4-item Morisky Medication Adherence Scale (MMAS-4) and 2item cost-related nonadherence (CRN-2) scale at Year 11. Factors (demographic, health status, and access to care) were examined for association with the MMAS-4 and then for association with the CRN-2 scale. Results: Nonadherence per the MMAS-4 and CRN-2 scale was reported by 40.7% and 7.7% of participants, respectively, with little overlap (3.7%). Multivariable logistic regression analyses found that black race was significantly associated with nonadherence per the MMAS-4 (P ¼ 0.002) and the CRN-2 scale (P ¼ 0.005). Other correlates of nonadherence per the MMAS-4 (with independent associations) included having cancer (P ¼ 0.04), a history of falls (P ¼ 0.02), sleep disturbances (P ¼ 0.04) and having a hospitalization in the previous 6 months (P ¼ 0.005). Conversely, being unmarried (P ¼ 0.049), having worse self-reported health (P ¼ 0.04) and needs being poorly met by income (P ¼ 0.02) showed significant independent associations with nonadherence per the CRN-2 scale. Conclusions: Self-reported medication nonadherence was common in older adults with chronic cardiovascular conditions and only one factor -race -was associated with both types. The research implication of this finding is that it highlights the need to measure both types of self-reported nonadherence in older adults. Moreover, the administration of these quick measures in the clinical setting should help identify specific actions such as patient education or greater use of generic medications or pill boxes that may address barriers to medication nonadherence.
Variation in antidiabetic medication intensity among medicare beneficiaries with diabetes mellitus
The American Journal of Geriatric Pharmacotherapy, 2007
Background: Recent guidelines for treating older patients with diabetes mellitus (DM) and significant disease burden place less emphasis on glycemic control and stress the potential harms that may arise from adherence to strict regimens with antidiabetic medications. However, there are few empirical benchmarks against which clinicians can compare their prescribing practices for patients who have DM and varying levels of comorbidity. Objective: The current study had 2 goals: (1) to provide national estimates showing how the intensity of antidiabetic medication regimens for Medicare beneficiaries with DM varies by level of medical spending (a proxy for overall disease burden); and (2) to identify potential predictive factors associated with the observed differences. Methods: This study analyzed 2002 Medicare Current Beneficiary Survey (MCBS) data to benchmark intensity of antidiabetic medication regimens for Medicare beneficiaries with DM arrayed by decile of cumulative medical care spending. The study involved 3 steps: (1) stratification of the study population into 10 mutually exclusive deciles by cumulative all-source annual medical spending; (2) assessment of the unconditional association between decilc assignment and intensity of antidiabetic medication use; and (3) identification of mediating factors that differentially explain medication intensity across the spectrum of disease burden. We evaluated 3 outcomes: (1) prevalence of any antidiabetic agent in 2002; (2) annual utilization rates for 5 different classes of oral hypoglycemic agents (sulfonylurea, metformin, thiazolidinedione, c~-glucosidase inhibitors, and meglitinides) plus insulins; and (3) counts of annual prescription fills. Results: The final study sample comprised 1956 Medicare beneficiaries representing 23.1% of the MCBS sample after exclusions. We found a pronounced inverted U-shaped pattern in intensity of antidiabetic treatment. Compared with individuals in the group with the highest prevalence of antidiabetic use (decile 7), the unadjusted treatment odds ratios were 0.40 in decile 1 (95% CI, 0.26-0.60) and 0.54 in decile 10 (95% CI, 0.36-0.81). We found similar patterns in the complexity of drug regimens and numbers of antidiabetic prescriptions filled among users. Controlling for disease severity and other factors eliminated the inverted U-shaped pattern among higher cost beneficiaries but not for those in the lower spending deciles. Conclusions: This national study found that high-cost Medicare beneficiaries with DM received substantially less intensive antidiabctic regimens compared with those incurring more modest medical expenditures in 2002. Longitudinal analysis is necessary to determine whether this finding indicates suboptimal therapy or has a more benign explanation. However, the magnitude of the association warrants the attention of clinicians who treat elderly and disabled diabetic patients with high disease burden.
JAMA Internal Medicine, 2017
IMPORTANCE Medication adherence is essential to diabetes care. Patient-physician language barriers may affect medication adherence among Latino individuals. OBJECTIVE To determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications. DESIGN, SETTING, AND PARTICIPANTS This observational study was conducted from January 1, 2006, to December 31, 2012, at a large integrated health care delivery system with professional interpreter services. Insured patients with type 2 diabetes, including English-speaking white, English-speaking Latino, or limited English proficiency (LEP) Latino patients with newly prescribed diabetes medication. EXPOSURES Patient race/ethnicity, preferred language, and physician self-reported Spanish-language fluency. MAIN OUTCOMES AND MEASURES Primary nonadherence (never dispensed), early-stage nonpersistence (dispensed only once), late-stage nonpersistence (received Ն2 dispensings, but discontinued within 24 months), and inadequate overall medication adherence (>20% time without sufficient medication supply during 24 months after initial prescription). RESULTS Participants included 21 878 white patients, 5755 English-speaking Latino patients, and 3205 LEP Latino patients with a total of 46 131 prescriptions for new diabetes medications. Among LEP Latino patients, 50.2% (n = 1610) had a primary care physician reporting high Spanish fluency. For oral medications, early adherence varied substantially: 1032 LEP Latino patients (32.2%), 1565 English-speaking Latino patients (27.2%), and 4004 white patients (18.3%) were either primary nonadherent or early nonpersistent. Inadequate overall adherence was observed in 1929 LEP Latino patients (60.2%), 2975 English-speaking Latino patients (51.7%), and 8204 white patients (37.5%). For insulin, early-stage nonpersistence was 42.8% among LEP Latino patients (n = 1372), 34.4% among English-speaking Latino patients (n = 1980), and 28.5% among white patients (n = 6235). After adjustment for patient and physician characteristics, LEP Latino patients were more likely to be nonadherent to oral medications and insulin than English-speaking Latino patients (relative risks from 1.11 [95% CI, 1.06-1.15] to 1.17 [95% CI, 1.02-1.34]; P < .05) or white patients (relative risks from 1.36 [95% CI, 1.31-1.41] to 1.49 [95% CI, 1.32-1.69]; P < .05). English-speaking Latino patients were more likely to be nonadherent compared with white patients (relative risks from 1.23 [95% CI, 1.19-1.27] to 1.30 [95% CI, 1.23-1.39]; P < .05). Patient-physician language concordance was not associated with rates of nonadherence among LEP Latinos (relative risks from 0.92 [95% CI, 0.71-1.19] to 1.04 [95% CI, 0.97-1.1]; P > .28). CONCLUSIONS AND RELEVANCE Nonadherence to newly prescribed diabetes medications is substantially greater among Latino than white patients, even among English-speaking Latino patients. Limited English proficiency Latino patients are more likely to be nonadherent than English-speaking Latino patients independent of the Spanish-language fluency of their physicians. Interventions beyond access to interpreters or patient-physician language concordance will be required to improve medication adherence among Latino patients with diabetes.
Journal of Advanced Medical and Dental Sciences Research, 2019
Background: Medication-taking behavior is complex and involves patient, clinician, and health system factors. The present study was conducted to determine prevalence of nonadherence to diabetic medication. Materials & Methods: The present community based study was conducted on 128 patients of type II diabetes mellitus of both genders. Place of treatment, satisfaction, cost of treatment, type of treatment, satisfaction with treatment and perceived knowledge about diabetes, complications, and effects of missing doses were also recorded. Medication adherence was measured using Morisky Medication Adherence Scale. Results: Out of 128 patients, males were 88 and females were 40. There was high significant difference in non-adherence to diabetic medication (P< 0.05). Reason for poor adherence were poor knowledge about disease in 45, myths in 63, distance from medical facility in 19, cost of treatment in 35, lack of satisfaction in 30 and forget to take medication in 42. The difference was significant (P< 0.05). Conclusion: Reason for poor adherence was poor knowledge about disease, myths, distance from medical facility, cost of treatment, lack of satisfaction and forget to take medication.
The nonadherence to prescriptions among type 2 diabetes patients, and its determining factors
2024
The aim is to clarify the prevalence of nonadherence to antidiabetic therapies among type 2 diabetes mellitus (T2DM) patients and identify its causes. Methods: A three-part questionnaire (general background, Knowledge-Attitude-Practice section, and nonadherence reasons) was developed. In total 324 diabetic patients were surveyed via telephone. The evaluation of patient adherence included both direct questions on adherence and a summary of patient responses to nonadherence comments. The analysis was performed on StataCorp Stata 14.2, and included descriptive analysis, simple and multivariate logistic regression. Findings: Among the sociodemographic variables, age group, work level, and alcohol consumption may influence medication adherence. The comorbidity status of patients was also of relevance. Both variables had stronger relationships with adherence to anti-diabetic treatments compared to those with no comorbidities or no additional medicines. A strength of the study is that it addresses various medical diseases and attitudes about them, as well as a wide range of causes for non-adherence to non-diabetic medications.
Value in Health, 2009
To determine adherence rates, transition probabilities, and factors associated with transition from higher to lower adherence in antihypertensive (AH) and lipid-lowering (LL) medications. Methods: California Medicaid data (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) were used to identify hypertensive patients with prescriptions for both AH and LL medications. Proportion of days covered (PDC) was used to define three adherence classifications: fully adherent (FA, PDC Ն 0.8), partially adherent (PA, 0.2 Յ PDC < 0.8), and nonadherent (NA, PDC < 0.2). Annual transition matrices documented the probability of adherence status changes. Results: Only 13% of the 5943 patients were FA to both drugs at baseline. Patients who were FA (60%) or NA (84%) to both drugs had high probability of maintaining status at year two (Y2). Significant variables associated with a transition from adherent to NA at Y2 included African American race (odds ratio [OR] 1.5), other race groups (OR 1.2), lack of Medicare eligibility (OR 1.3), and initiating LL therapy of fibric acid derivatives (OR 1.3) or niacin (OR 1.8). Conclusions: Patients FA or NA with both drugs at baseline were more likely to maintain their adherence status. Race, insurance coverage, and type of LL medication were significantly associated with transitioning from any adherence status to nonadherence. These findings may be useful in guiding cost-effectiveness analyses incorporating adherence estimates.