Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level

Wong, Edwin S.; Piette, John D.; Liu, Chuan Fen; Perkins, Mark; Maciejewski, Matthew L.; Jackson, George L.; Blough, David K.; Fihn, Stephan D.; Au, David H.; Bryson, Chris L.

doi:10.1097/mlr.0b013e318249cb74

Cited by 18 publications

(23 citation statements)

References 43 publications

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“…The final study sample included 280,603 diabetes patients who received care from 196 primary clinics for which data were also available from the primary care survey. These patients were a subset of a sample documented in a prior study [17]. …”

Section: Methodsmentioning

confidence: 99%

“…For example, if 140 of 200 patients in a clinic had 80% or greater adherence, then the clinic would have an adherence rate of 70%. To account for differences in patient characteristics across clinics that might influence clinic-level adherence scores, we risk adjusted clinic-level adherence scores using a hierarchical logistic regression model (see Wong, Piette et al [17] for more details). Specifically, the model first estimated adherence at the patient level adjusting for patient characteristics known to impact adherence such as race and the presence of comorbid depression.…”

Section: Methodsmentioning

confidence: 99%

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Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Kocarnik

Liu

Wong

et al. 2012

BMC Health Serv Res

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BackgroundAlthough oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence.MethodsThis retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression.ResultsWe found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck.ConclusionsPharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Kocarnik

Liu

Wong

et al. 2012

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although compelling anecdotes and personal experiences with “disobedient patients” are powerful influences to practicing health care professionals, these types of patients probably contribute only a small part to the overall problem of medication non-adherence 40. As a result, individual patient factors are known to contribute minimally (if at all) to the overall occurrence of non-adherence observed in population-based studies 42,43…”

Section: Predictors Of Non-adherencementioning

confidence: 99%

“…Not only are individual factors weakly predictive on their own, multivariable models do not predict or explain more than a fraction of the massive burden of non-adherence observed in population studies 42,43. For example, Wong et al could explain less than 4% of all cases of non-adherence (measured from prescription refill databases) using available patient-level and clinic-level factors from administrative data sources among 444,418 patients with diabetes registered in the National Veterans Affairs database in the US 43.…”

Section: Predictors Of Non-adherencementioning

confidence: 99%

Nonadherence in type 2 diabetes: practical considerations for interpreting the literature

Blackburn

Swidrovich²,

Lemstra³

2013

PPA

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The rising prevalence of type 2 diabetes poses a serious threat to human health and the viability of many health care systems around the world. Although several prescription medications can play a vital role in controlling symptoms and preventing complications, non-adherence to these therapies is highly prevalent and has been linked to increases in morbidity, mortality, and health care costs. Although a vast array of significant adherence predictors has been identified, the ability to explain or predict non-adherence with known risk-factors remains poor. Further, the definitions, outcomes, and various measures used in the non-adherence literature can be misleading for the unfamiliar reviewer. In this narrative review, a practical overview of important considerations for interpreting adherence endpoints and measures is discussed. Also, an organizational framework is proposed to consider published adherence interventions. This framework may allow for a unique appreciation into areas of limited knowledge and thus highlights targets for future research.

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“…In a study of records from more than 56,000 veterans with type 2 diabetes taking OADs (years 2000–2002), 23% of patients were categorized as non-adherent, as defined by a medication possession ratio (MPR) <80% after 1 year [80]. A later re-evaluation of the VA database (years 2005–2007) demonstrated a somewhat higher rate of non-adherence (30%) using the 1-year MPR ( N = 444,418) [81]. One study that reviewed the medical literature for data on adherence (years 2000–2005) reported similar results, showing that 42% of patients had a 1-year MPR <80% (35 studies) [82].…”

Section: Sustainability Of the Prescribed Regimenmentioning

confidence: 99%

Incretin-Based Therapies: Focus on Effects Beyond Glycemic Control Alone

Davidson

2013

Diabetes Ther

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Type 2 diabetes is associated with a high prevalence of comorbidities resulting from hypertension, dyslipidemia, and hyperglycemia. Inadequate management of these risk factors will eventually result in detrimental health consequences. Thus, the effect of a drug on factors such as weight, cardiovascular (CV) risk factors, and adherence is important to consider. A review was undertaken of the recent medical literature describing the extraglycemic characteristics of the two classes of incretin-based therapies—glucagon-like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 (DPP-4) inhibitors. PubMed searches were performed to identify published data on incretin therapies that describe their effects on CV risk factors, CV events, and factors related to medication adherence. The maintenance or loss of weight associated with the use of GLP-1RAs and DPP-4 inhibitors is well described in the medical literature. These agents also appear to be associated with a modest decrease in blood pressure and a reduced risk of CV events. In addition, several characteristics of incretin therapies may improve rates of medication adherence, such as generally favorable tolerability profiles (particularly with DPP-4 inhibitors), the availability of formulations that simplify treatment regimens, and a low risk for hypoglycemia. The literature on incretin therapies describes a number of clinical characteristics that are relevant to the management of extraglycemic risk factors. As part of a holistic treatment strategy, these properties constitute important considerations for tailoring therapy to individual patients with type 2 diabetes.

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Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level

Cited by 18 publications

References 43 publications

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Nonadherence in type 2 diabetes: practical considerations for interpreting the literature

Incretin-Based Therapies: Focus on Effects Beyond Glycemic Control Alone

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