Factors associated with medication nonadherence among Medicare low-income subsidy beneficiaries with diabetes, hypertension, and/or heart failure

Tsang, Chi Chun Steve; Browning, Jamie A.; Todor, L.; Dougherty, Samantha; Li, Minghui Sam; Borja‐Hart, Nancy; Hines, Lisa; Wang, Junling

doi:10.18553/jmcp.2021.27.8.971

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…However, these cross-sectional studies did not allow us to identify the mechanism for changes in disparities or to evaluate whether these changes were potentially causal. Another five studies considered interactions between a policy of interest (e.g., low-income subsidy eligibility) and race/ethnicity in the context of cross-sectional analysis or presented models stratified by policy (Biggers et al, 2016; Camacho et al, 2017; Roberts et al, 2023; Tsang et al, 2021; Zissimopoulos et al, 2015). These methods may have been better than stepwise models for understanding the impact of policy on disparities; however, they still could not account for unobserved differences across individuals grouped by policy eligibility.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review

Kaplan,

Waters,

Clear

et al. 2024

Med Care Res Rev

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Prescription drug cost-sharing is a barrier to medication adherence, particularly for low-income and minority populations. In this systematic review, we examined the impact of prescription drug cost-sharing and policies to reduce cost-sharing on racial/ethnic and income disparities in medication utilization. We screened 2,145 titles and abstracts and identified 19 peer-reviewed papers that examined the interaction between cost-sharing and racial/ethnic and income disparities in medication adherence or utilization. We found weak but inconsistent evidence that lower cost-sharing is associated with reduced disparities in adherence and utilization, but studies consistently found that significant disparities remained even after adjusting for differences in cost-sharing across individuals. Study designs varied in their ability to measure the causal effect of policy or cost-sharing changes on disparities, and a wide range of policies were examined across studies. Further research is needed to identify the types of policies that are best suited to reduce disparities in medication adherence.

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Section: Resultsmentioning

confidence: 99%

The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review

Kaplan,

Waters,

Clear

et al. 2024

Med Care Res Rev

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“…[53] Finally, patients residing in the West census region experienced a lower relative net benefit than those in Northeast region, possibly due to their lower rates of medication adherence compared to the Northeast region. [54] Caution should be exercised when interpreting the findings of this study, as there are several limitations to consider. First, certain patient-level socioeconomic characteristics that could affect the study outcome could not be evaluated, as the analysis primarily relied on information obtained from Medicare administrative data.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of medication therapy management among Medicare population and across racial/ethnic groups

Tsang,

Wang,

Shih

2024

Medicine

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Background: Inappropriate medication utilization among older adults is a pressing concern in the United States, owing to its high prevalence and the consequential detrimental impact it engenders. The adverse effects stemming from the inappropriate use of medication may be unequally borne by racial/ethnic minority populations, calling for greater efforts towards promoting equity in healthcare. The study objective was to assess the cost-effectiveness of Medication Therapy Management (MTM) services among Medicare beneficiaries and across racial/ethnic groups. Methods: Medicare administrative data from 2016 to 2017 linked to Area Health Resources Files were used to analyze Medicare fee-for-service patients aged 65 or above with continuous Parts A/B/D coverage. The intervention group included new MTM enrollees in 2017; the control group referred to patients who met the general MTM eligible criteria but did not enroll in 2016 or 2017. The 2 groups were matched using a propensity score method. Effectiveness was evaluated as the proportion of appropriate medication utilization based on performance measures developed by the Pharmacy Quality Alliance. Costs were computed as total healthcare costs from Medicare perspective. A multivariable net benefit regressions with a classic linear model and Bayesian analysis were utilized. Net benefit was calculated based on willingness-to-pay thresholds at various multiples of the gross domestic product in 2017. Three-way interaction terms among dummy variables for MTM enrollment, 2017, and racial/ethnic minority groups were incorporated in a difference-in-differences study design. Results: After adjusting for patient characteristics, the findings indicate that MTM receipt was associated with incremental net benefit among each race and ethnicity. For instance, the net benefit of MTM among the non-Hispanic White patients was $2498 (95% confidence interval = $1609, $3386) at a willingness-to-pay value of $59,908. The study found no significant difference in net benefits for MTM services between minority and White patients. Conclusion: The study provides evidence that MTM is a cost-effective tool for managing medication utilization among the Medicare population. However, MTM may not be cost-effective in reducing racial/ethnic disparities in medication utilization in the short term. Further research is needed to understand the long-term cost-effectiveness of MTM on racial/ethnic disparities.

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“…In the stepwise multivariable Cox regression analysis, young age and NICM were associated with a low compliance rate. Previously published data to define factors, which are associated with the likelihood of medication non‐adherence among Medicare low‐income subsidy recipients with type 2 diabetes, hypertension or heart failure showed that both young age and male gender are associated with low compliance 11 . Recently published descriptive data showed that the compliance rate regarding wearing a WCD is comparable in males and females 12,13 …”

Section: Discussionmentioning

confidence: 99%

“…Previously published data to define factors, which are associated with the likelihood of medication non-adherence among Medicare low-income subsidy recipients with type 2 diabetes, hypertension or heart failure showed that both young age and male gender are associated with low compliance. 11 Recently published descriptive data showed that the compliance rate regarding wearing a WCD is comparable in males and females. 12,13 A further important aspect is that NICM is also associated with low compliance.…”

Section: Predictors Of Compliancementioning

confidence: 99%

Age differences of patients treated with wearable cardioverter defibrillator: Data from a multicentre registry

El‐Battrawy

Tenbrink

Kovacs³

et al. 2023

Eur J Clin Investigation

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Background Wearable cardioverter defibrillators (WCD) are used as a ‘bridging’ technology in patients, who are temporarily at high risk for sudden cardiac death (SCD). Several factors should be taken into consideration, for example patient selection, compliance and optimal drug treatment, when WCD is prescribed. We aimed to present real‐world data from seven centres from Germany and Switzerland according to age differences regarding the outcome, prognosis, WCD data and compliance. Materials and Methods Between 04/2012 and 03/2021, 1105 patients were included in this registry. Outcome data according to age differences (old ≥45 years compared to young <45 years) were analysed. At young age, WCDs were more often prescribed due to congenital heart disease and myocarditis. On the other hand, ischaemic cardiomyopathy (ICM) was more present in older patients. Wear days of WCD were similar between both groups (p = .115). In addition, during the WCD use, documented arrhythmic life‐threatening events were comparable [sustained ventricular tachycardia: 5.8% vs. 7.7%, ventricular fibrillation (VF) .5% vs. .6%] and consequently the rate of appropriate shocks was similar between both groups. Left ventricular ejection fraction improvement was documented over follow‐up with a better improvement in younger patients as compared to older patients (77% vs. 63%, p = .002). In addition, at baseline, the rate of atrial fibrillation was significantly higher in the older age group (23% vs. 8%; p = .001). The rate of permanent cardiac implantable electronic device implantation (CiED) was lower in the younger group (25% vs. 36%, p = .05). The compliance rate defined as wearing WCD at least 20 h per day was significantly lower in young patients compared to old patients (68.9% vs. 80.9%, p < .001). During the follow‐up, no significant difference regarding all‐cause mortality or arrhythmic death was documented in both groups. A low compliance rate of wearing WCD is predicted by young patients and patients suffering from non‐ischaemic cardiomyopathies. Conclusion Although the compliance rate in different age groups is high, the average wear hours tended to be lower in young patients compared to older patients. The clinical events were similar in younger patients compared to older patients.

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Factors associated with medication nonadherence among Medicare low-income subsidy beneficiaries with diabetes, hypertension, and/or heart failure

Cited by 11 publications

References 20 publications

The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review

The Impact of Prescription Drug Coverage on Disparities in Adherence and Medication Use: A Systematic Review

Cost-effectiveness of medication therapy management among Medicare population and across racial/ethnic groups

Age differences of patients treated with wearable cardioverter defibrillator: Data from a multicentre registry

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