Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis

Abstract

Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.

The association between comprehensive medication review and medication adherence among medicare beneficiaries with chronic obstructive pulmonary disease

“…Previous research has found that MTM programs can improve medication adherence rates, highlighting the value of such intervention in medication management led by pharmacists or other qualified providers. 25 , 26 Results from this study also reconfirmed the benefits of CMRs (a required component of the MTM services) on the population of interest. As stated above, one possible reason for this population's low medication adherence rate is the complexity of COPD medication regimens.…”

“…24 It has been found previously in the U.S. and other countries that MTM programs, including CMRs, are associated with higher medication adherence rates, reduced healthcare costs, and decreased racial/ethnic disparities in medication nonadherence rates. 25 , 26 , 27 …”

Racial and ethnic disparities in Medicare Part D medication therapy management services utilization

“… 24 Even among complex Alzheimer's patients, receiving a CMR reduces ethnic disparities in medication adherence to statin medications between Hispanic and White patients. 25 The current study's findings reveal that racial/ethnic minorities are not receiving all MTM services as equally as White patients, suggesting disparities in receiving the associated benefits. This could worsen the already existing and well-documented racial/ethnic disparities in health care.…”

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

“…Two studies reported on potentially inappropriate medication use—“drugs that should generally be avoided because they are ineffective or pose an unnecessarily high risk for older adults, and drugs that are appropriate to use in older persons only at certain doses, frequencies, or duration of therapies.” 58 One study reported higher rates of potentially inappropriate medication use in Hispanic Americans compared to NHW persons 58 and another found higher rates of concurrent use of medications with anti‐cholinergic properties and anti‐dementia medications in NHW and Native Hawaiians compared to Asian Americans 59 . Finally, several studies reported racial/ethnic differences in patterns of use of drugs for hypertension and other medical conditions in PLWD 46,60,61 . Among the studies of medication for other medical conditions, a Medicare Comprehensive Medication Review was found to reduce disparities in statin non‐adherence for Hispanic American PLWD 61 .…”

“… 59 Finally, several studies reported racial/ethnic differences in patterns of use of drugs for hypertension and other medical conditions in PLWD. 46 , 60 , 61 Among the studies of medication for other medical conditions, a Medicare Comprehensive Medication Review was found to reduce disparities in statin non‐adherence for Hispanic American PLWD. 61 In a related study, Hispanic and Asian Americans were more likely to be similarly enrolled in Medication Therapy Management (MTM) programs compared to NHW, and Black Americans were less likely to be enrolled in MTM than NHW.…”