Impact of changes in pill appearance in the adherence to angiotensin receptor blockers and in the blood pressure levels: a retrospective cohort study

Abstract

ObjectiveTo assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment.DesignRetrospective cohort study of a random sample of consecutive patients collecting their medication.Setting40 community pharmacies in Alicante (Southeast Spain).Participants602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included.Main outcome measuresPrevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables.Results161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136–148) than in those who did not have a change (median BP 127 mm Hg; IQR 118–135; p<0.001).ConclusionsThere was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.

Consequences on economic outcomes of generic versus brand-name drugs used in routine clinical practice: the case of treating peripheral neuropathic pain or generalized anxiety disorder with pregabalin

“…In addition, in the multiple linear regression model, the cost (pNP, GAD) was associated with generic pregabalin, non-adherence (persistence/MPR) and lower clinical effectiveness. The temporal relationship between nonadherence, lower clinical effectiveness and greater healthcare resource utilization seems consistent in the literature reviewed [18,19,32,39].…”

“…In recent published studies, Lumbreras found that switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled blood pressure than no change in pharmacological treatment or change only in package but not in pill appearance [19]. Cheng showed that higher suicide rates were reported in patients who used generic versus brand-name medicinal products [40].…”

“…The disadvantage of a generic drug is the confusion it may cause in patients with respect to its commercial name (active substance) and its presentation or form (bioappearance), especially in older people [14,16,17]. This potential confusion may lead to medication errors, which could in turn lead to treatment nonadherence, cause a possible decrease in clinical effectiveness, trigger the onset of adverse effects and generate a potential increase in associated healthcare costs [18,19]. This change in pill appearance (physical characteristics of shape, color, size and packaging that identify medicines) which occurs when generic drugs are supplied by different brands over time might result in higher levels of treatment discontinuation or less likely to be adherent [19].…”

“…This potential confusion may lead to medication errors, which could in turn lead to treatment nonadherence, cause a possible decrease in clinical effectiveness, trigger the onset of adverse effects and generate a potential increase in associated healthcare costs [18,19]. This change in pill appearance (physical characteristics of shape, color, size and packaging that identify medicines) which occurs when generic drugs are supplied by different brands over time might result in higher levels of treatment discontinuation or less likely to be adherent [19]. Therefore, administration of a generic drug could be considered a factor to be taken into account, particularly in some countries, like Spain, where generic substitution is allowed and their governments encourage doctors to prescribe them.…”

Treatment persistence and adherence and their consequences on patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain: a retrospective cost-consequences analysis

“…This potential confusion may lead to medication errors, which could in turn lead to treatment non-adherence, cause a possible decrease in clinical effectiveness, trigger the onset of adverse effects and generate a potential increase in associated healthcare costs [ 18 – 20 ]. The change in pill appearance (physical characteristics of shape, color, size and packaging that identify medicines) which occurs when generic drugs are supplied by different brands over time might result in higher levels of treatment discontinuation or mean that patients are less likely to adhere to treatment [ 19 ]. Therefore, administration of a generic drug could be considered a factor to be taken into account, particularly in some countries, like Spain, where generic substitution is allowed and their governments encourage doctors to prescribe them.…”