Association between adherence to antihypertensive medications and health outcomes in middle and older aged community dwelling adults; results from the Irish longitudinal study on ageing

Walsh, Caroline; Cahir, Caitriona; Bennett, Kathleen

doi:10.1007/s00228-019-02699-w

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…Similar to a previous study of TILDA participants, 22 no significant relationship between suboptimal medication adherence and subsequent self-reported hospitalizations was observed. This is in contrast to the existing literature, which has suggested a significant relationship between medication adherence and objective measures of hospitalization.…”

Section: Discussionsupporting

confidence: 88%

“…Previously, good adherence to antihypertensive medication (PDC ≥ 80%) in adults aged ≥50 years was associated with a 9% decrease in subsequent GP visit rate, in comparison to poor adherence. 22 The higher incidence rate observed in this study may be attributable to the increased health care requirements of older, multimorbid patients. 12 Suboptimal adherence groups contained higher proportions of participants on ≥10 medications.…”

Section: Discussionmentioning

confidence: 66%

“…The following covariates were included in multivariable models, a priori, as identified from the literature 3,22 : age (continuous); gender (male/female); highest education level attained ([1] none or primary level, [2] secondary level, or [3] third level or higher); depressive symptoms, as measured using the Centre for Epidemiologic Depression Scale 23 ([1] none [score 0-7], [2] subclinical depression [score 8-15], or [3] clinical depression [score > 15]); functional disability (having ≥1 impairment of activities of daily living or instrumental activities of daily living); polypharmacy (categorized as: [1] 5-9, [2] 10-14, or [3] 15+ regular medications); living arrangements ([1] living alone, [2] living with spouse only, or [3] living with others); and private health insurance (coverage or not). Baseline self-reported health care utilization in the 12 months preceding wave 1 was included in multivariable regression models; specific variable(s) included depended on the outcome.…”

Section: Methodsmentioning

confidence: 99%

“…Negative binomial regression was used to estimate the association between medication adherence (summary and adherence patterns) and the number of self-reported GP, ED, outpatient, and inpatient hospital visits, respectively, at wave 2. Negative binomial regression is commonly used to model nonparametric count data 22,27 and demonstrated superior model fit to both Poisson and zero-inflated regression models, respectively. The AA variable (CMA7) was analyzed on a continuum from 0 to 1, and a 1-unit increase in this variable is equivalent to a 100% increase in adherence, relative to baseline.…”

Section: Methodsmentioning

confidence: 99%

“…The following covariates were included in multivariable models, a priori, as identified from the literature 3,22 : age (continuous); gender (male/female); highest education level attained ( [1] private health insurance (coverage or not). Baseline selfreported health care utilization in the 12 months preceding wave 1 was included in multivariable regression models; specific variable(s) included depended on the outcome.…”

Section: Covariatesmentioning

confidence: 99%

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Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

2020

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Background: The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear. Objective: To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization. Methods: This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented. Results: Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate. Conclusion and Relevance: Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 66%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The following covariates were included in multivariable models, a priori, as identified from the literature 3,22 : age (continuous); gender (male/female); highest education level attained ( [1] private health insurance (coverage or not). Baseline selfreported health care utilization in the 12 months preceding wave 1 was included in multivariable regression models; specific variable(s) included depended on the outcome.…”

Section: Covariatesmentioning

confidence: 99%

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Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

2020

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The Health Service Executive—Primary Care Reimbursement Services Database (HSE-PCRS) in Ireland

Sinnott

Cahir

Bennett

2021

Databases for Pharmacoepidemiological Research

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Impact of coordinated care on adherence to antihypertensive medicines among adults experiencing polypharmacy in Australia

Lin,

de Oliveira Costa,

Pearson

et al. 2024

Journal of Hypertension

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Background: Adherence to antihypertensives is key for blood pressure control. Most people with hypertension have several comorbidities and require multiple medicines, leading to complex care pathways. Strategies for coordinating medicine use can improve adherence, but cumulative benefits of multiple strategies are unknown. Methods: Using dispensing claims for a 10% sample of eligible Australians, we identified adult users of antihypertensives during July 2018–June 2019 who experienced polypharmacy (≥5 unique medicines). We measured medicine use reflecting coordinated medicine management in 3 months before and including first observed dispensing, including: use of simple regimens for each cardiovascular medicine; prescriber continuity; and coordination of dispensings at the pharmacy. We measured adherence (proportion of days covered) to antihypertensive medicines in the following 12 months, and used logistic regression to assess independent associations and interactions of adherence with these measures of care. Results: We identified 202 708 people, of which two-thirds (66.6%) had simple cardiovascular medicine regimens (one tablet per day for each medicine), two-thirds (63.3%) were prescribed >75% of medicines from the same prescriber, and two-thirds (65.5%) filled >50% of their medicine on the same day. One-third (28.4%) of people experienced all three measures of coordinated care. Although all measures were significantly associated with higher adherence, adherence was greatest among people experiencing all three measures (odds ratio = 1.63; 95% confidence interval: 1.55–1.72). This interaction was driven primarily by effects of prescriber continuity and dispensing coordination. Conclusions: Coordinating both prescribing and dispensing of medicines can improve adherence to antihypertensives, which supports strategies consolidating both prescribing and supply of patients’ medicines.

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Association between adherence to antihypertensive medications and health outcomes in middle and older aged community dwelling adults; results from the Irish longitudinal study on ageing

Cited by 6 publications

References 40 publications

Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

The Health Service Executive—Primary Care Reimbursement Services Database (HSE-PCRS) in Ireland

Impact of coordinated care on adherence to antihypertensive medicines among adults experiencing polypharmacy in Australia

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