Predictors of Medication-Refill Adherence in an Indigent Rural Population

Schectman, Joel M.; Bovbjerg, Viktor E.; Voss, John D.

doi:10.1097/00005650-200212000-00016

Cited by 62 publications

(63 citation statements)

References 43 publications

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“…10,11 Table 1 lists medication classes included. Injectable and powder medications were excluded because the days supply reported may not accurately reflect true usage.…”

Section: Study Population and Data Sourcementioning

confidence: 99%

Adherence to Chronic Disease Medications among New York City Medicaid Participants

2012

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Medication adherence is critical for cardiovascular disease prevention and control. Local health departments are well positioned to address adherence issues, however relevant baseline data and a mechanism for monitoring impact of interventions are lacking. We performed a retrospective analysis using New York State Medicaid claims from 2008 to 2009 to describe rates and predictors of adherence among New York City Medicaid participants with dyslipidemia, diabetes, or hypertension. Adherence was measured using the medication possession ratio, and multivariable logistic regression was used to assess factors related to adherence. Medication regimen adherence was 63%. Greater adherence was observed in those who were older, male, and taking medications from ≥3 drug classes. Compared with whites, blacks and Hispanics were less likely to be adherent (adjusted odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.65-0.70 and adjusted OR=0.76, 95% CI: 0.73-0.78, respectively), while Asians were as likely. Medication adherence was inadequate and racial disparities were identified in NYC Medicaid participants on stable medication regimens for chronic disease. This study demonstrates a claims-based model that may be used by local health departments to monitor and evaluate efforts to improve adherence and reduce disparities.

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“…10,11 Table 1 lists medication classes included. Injectable and powder medications were excluded because the days supply reported may not accurately reflect true usage.…”

Section: Study Population and Data Sourcementioning

confidence: 99%

Adherence to Chronic Disease Medications among New York City Medicaid Participants

2012

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“…42 Half of the studies specified the insurance scheme that patients were enrolled in: two (US) studies included predominantly indigent populations (adults who do not have health insurance and are not eligible for Medicaid, Medicare or private health insurance), 39,43 two studies were conducted among Medicaid patients, 44,45 four studies were set in Veterans Health Administrations 37,40,42,46 and one study used data from Kaiser Permanente health-care delivery sites. 47 All of the studies were conducted in the USA.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…For the three studies that provided details of the setting, one was conducted in a primary care clinic, 39 one was conducted among patients seen in primary care, mental health clinics, inpatient services and integrated mental health primary care, 37 and one was conducted in an internal medicine practice. 43 Faris et al 48 investigated patients in four specialty therapeutic categories (multiple sclerosis, rheumatoid arthritis, oncology and growth hormone) that are not typically primarily managed in primary care in England, but insufficient information is presented to determine in which setting these patients were being treated.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…38,40,47 The remaining four studies considered (1) 30 days' versus 60 days' supply, 39 (2) 100 days' versus 34 days' supply, 44 (3) 90 days versus < 90 days' supply 37 and (4) prescription lengths of ≤ 90 days. 43 The number of medications examined in a single study ranged from one 40 to 'any medication for a chronic condition'. 49 The most common clinical classes evaluated were lipid-lowering agents, The study periods ranged from 3 months 46 to 7 years; 37 only one study was conducted over a period of less than 1 year, 46 six studies were conducted over a 12-month period 32,36,42,43,45,47 and eight studies were conducted over a period of more than 1 year.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…43 The number of medications examined in a single study ranged from one 40 to 'any medication for a chronic condition'. 49 The most common clinical classes evaluated were lipid-lowering agents, The study periods ranged from 3 months 46 to 7 years; 37 only one study was conducted over a period of less than 1 year, 46 six studies were conducted over a 12-month period 32,36,42,43,45,47 and eight studies were conducted over a period of more than 1 year. 35,37,[39][40][41]44,48,49 Ryvkin et al 38 did not report the length of their study.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Miani

Martin

Exley

et al. 2017

Health Technol Assess

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BackgroundTo reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain.ObjectiveTo evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care.Design/data sourcesThe design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios.Review methodsIn the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available.ResultsAn exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference –0.45, 95% confidence interval –0.65 to –0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years.LimitationsThe available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy.ConclusionsAlthough the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care.Future workThere is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed.Study registrationThis study is registered as PROSPERO CRD42015027042.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Impact of Concurrent Medication Use on Statin Adherence and Refill Persistence

Grant¹,

O'Leary²,

Weilburg³

et al. 2004

Arch Intern Med

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In this cohort, statin DMA was generally adequate, but RP was suboptimal. Patients with more concurrently prescribed medicines had higher DMA and better RP, even after adjusting for demographic factors and cardiovascular comorbidity. Physicians should not be deterred from initiating statin therapy by a patient's medical regimen complexity but should be alert for lack of therapy persistence, particularly in younger and healthier patients.

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Predictors of Medication-Refill Adherence in an Indigent Rural Population

Cited by 62 publications

References 43 publications

Adherence to Chronic Disease Medications among New York City Medicaid Participants

Adherence to Chronic Disease Medications among New York City Medicaid Participants

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Impact of Concurrent Medication Use on Statin Adherence and Refill Persistence

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