Does Medication Adherence Lower Medicare Spending among Beneficiaries with Diabetes (original) (raw)
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The American Journal of Medicine, 2020
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Patient Preference and Adherence
Background: Diabetes mellitus (D.M.) is a chronic metabolic disease caused by decreased insulin secretion, which increases the risk of cardiovascular diseases. Evidence has shown that statins reduce cardiovascular risk in patients with diabetes; moreover, most clinical guidelines recommend statins. Objective: This study aimed to assess the level and status of adherence to guidelines on statin prescription in patients with diabetes mellitus in a primary care setting in Palestine. Methods: A retrospective cross-sectional descriptive study was conducted at an ambulatory center in Palestine. Data were collected by auditing prescription records and reviewing medical charts of patients with diabetes who visited the clinic from February 15 to March 17, 2021. The collected data included patient characteristics, comorbidities, lipid profiles, and statin prescription. A chi-square test was used to evaluate the appropriateness of the prescribed statins with different demographic and clinical variables. Statistical significance was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data. Results: Out Of 262 diabetic patients included in the analysis, 74% were prescribed appropriate statin therapy according to the American Diabetes Association (ADA) guidelines, and 24% of patients had inappropriate statin therapy or needed statins. Furthermore, 82.8% were on high-intensity statins, while 11% were not taking any statins. More than 60% of patients had uncontrolled diabetes and hypertension. Conclusion: Most guidelines recommend statin therapy in diabetic patients owing to its benefits in preventing cardiovascular complications. In this study, most patients were on appropriate STATIN therapy; however, 50% of diabetic patients had LDL of more than 100 mg/dl, and 25% were not prescribed statins, increasing their risk of ASCVD. Therefore, we recommend strict adherence to the established guidelines on statins prescribed to patients with diabetes to prevent cardiovascular complications, save lives, and reduce healthcare costs.
Journal of managed care pharmacy : JMCP
The cardiovascular (CV) benefits of lipid-lowering therapy in older adults with hypercholesterolemia and underlying risk factors for coronary artery disease (CAD) have been well documented. Significant reductions in the risk of myocardial infarction (MI) and coronary death have been demonstrated with statin therapy, benefits that are of particular relevance in patients with diabetes. Managed care interventions with prescribers have increased the use of selected drugs such as statins. To (1) measure the increase in new users of statins associated with the implementation of a statin initiation intervention aimed at prescribers for Medicare Part D Medication Therapy Management Program (MTMP) members with diabetes or CAD and (2) estimate the potential cost savings associated with the projected reduction in CV events based on published controlled trials. Medicare Advantage Prescription Drug (MA-PD) and prescription drug plan (PDP) members of a pharmacy benefits manager (PBM) were identif...
Journal of managed care & specialty pharmacy, 2020
BACKGROUND: Patients with more than one chronic condition often receive care from several providers and facilities, which may lead to fragmentation of care. Poor care coordination in dual health care system use has been associated with increased emergency department visits, hospitalizations, and costs. OBJECTIVE: Dual health care system use is increasing among veterans, and we sought to evaluate the effect of dual health care system use on statin treatment in veterans with type 2 diabetes at high risk of cardiovascular events, using varying degrees of Centers for Medicare & Medicaid Services (CMS) services.
Utilization of Statins in Reducing Comorbidities of Diabetes Mellitus: A Systematic Review
Journal of Pharmacy Practice and Community Medicine, 2018
Background: Medical care for the patients with diabetes, especially medication regimens, has become more complex over time, producing a barrier to achieving evidence-based goals of treatment. National and international clinical guidelines in the prevention of cardiovascular risk in diabetics advocate the utilization of statin therapy in appropriate patients. In this review, we will systematically review about utilization of Statins in reducing Comorbidities of Diabetes Mellitus. Methods: We searched the various electronic databases such as: PUBMED, BMJ, LANCET, WHO Website, Unicef Website and Google Scholar for studies related about utilization of Statins in reducing Comorbidities of Diabetes Mellitus. We also checked reference lists of reviews and retrieved articles for additional studies. By systemic searches, we reviewed each paper and retrieved potentially relevant references. Results: Many landmark studies across the world like the Heart Protection Study (HPS), the largest trial to date, confirmed the findings of earlier primary and secondary across a wide range of patients, including those with diabetes mellitus. In diabetic patients, statin therapy was associated with a significant 22% reduction in the risk of a first vascular event. The collaborative Atorvastatin diabetes study (CARDS) a study that involved over 2,800 men and women with type 2 diabetes (aged 40-75 years) and at least one other CHD risk factor, was stopped early when patients in the statin group showed significant reductions in myocardial infarction, stroke, angina and revascularization. Various Clinical trials such as MRC/BHF Heart Protections Study, Collaborative Atorvastatin Diabetes Study (CARDS) etc. showed evidence for the benefits of statins in diabetes. Conclusion: An overwhelming amount of data that confirm the morbidity and mortality benefit of statin therapy in diabetes mellitus have been reported, both in primary and secondary prevention settings. National and international clinical guidelines in the prevention of cardiovascular risk in diabetics advocate the utilization of statin therapy in appropriate patients.
BMJ (Clinical research ed.), 2014
To evaluate the incremental increase in new onset diabetes from higher potency statins compared with lower potency statins when used for secondary prevention. Eight population based cohort studies and a meta-analysis. Six Canadian provinces and two international databases from the UK and US. 136,966 patients aged ≥ 40 years newly treated with statins between 1 January 1997 and 31 March 2011. Within each cohort of patients newly prescribed a statin after hospitalisation for a major cardiovascular event or procedure, we performed as-treated, nested case-control analyses to compare diabetes incidence in users of higher potency statins with incidence in users of lower potency statins. Rate ratios of new diabetes events were estimated using conditional logistic regression on different lengths of exposure to higher potency versus lower potency statins; adjustment for confounding was achieved using high dimensional propensity scores. Meta-analytic methods were used to estimate overall effe...
Journal of the American Geriatrics Society, 2008
Objectives-To determine whether prescription drug benefits are associated with the use of guideline recommended medications by older persons with type 2 diabetes mellitus. Design-Cross-sectional study Participants-A national sample of Medicare beneficiaries with diabetes aged ≥ 65 years and an indication for angiotensin-converting enzyme (ACE) inhibitor or angiotensin II-receptor blocker (ARB) use or increased risk of coronary heart disease (hypertension or current smoking) who participated in the 2003 Medicare Current Beneficiary Survey. Measurements-Prescription drug coverage was measured by self-report and verified by insurance claims. Outcome variables were only ACE/ARB or statin use, or combined ACE/ARB and statin use. Survey weighted multinomial logistic regression was used to identify the independent effect of drug coverage on one of two categories of recommended medication use (only ACE/ARB or statin, or combined ACE/ARB and statin) compared to the reference category of none after controlling for sociodemographics and health status. Results-The final study sample was 1,181 (weighted N = 4.0 million). Overall, 23% had no drug coverage, 16% Medicaid coverage, 43% employer coverage, 9% Medigap coverage, and 9% Veterans' Affairs (VA) or state-sponsored low-income coverage. Overall, 33% received both statins and ACE/ARBs, 44% only an ACE/ARB or statin, and 23% neither. After adjustment, VA and state-sponsored drug benefits were most strongly associated with combined ACE/ARB and statin use [RRR 4.83 (95% CI 2.24-10.4)], followed by employer-sponsored coverage [RRR 2.60 (95% CI 1.67-4.03)]. Conclusions-Prescription drug benefits from VA and state-sponsored drug programs are strongly associated with use of recommended medications by older adults with DM.