Race/Ethnicity, Disability, and Medication Adherence Among Medicare Beneficiaries with Heart Failure

Zhang, Yuting; Baik, Seo Hyon

doi:10.1007/s11606-013-2692-x

Cited by 73 publications

(61 citation statements)

References 19 publications

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“…Although similar patterns of nonadherence have been found by others (Zhang & Baik, 2014) our findings suggest that the issue of medication adherence is exceedingly complex for many persons with HF, especially Blacks. Many of these patients were taking complex medication regimens, with substantial numbers of medications.…”

Section: Discussionsupporting

confidence: 88%

“…In an analysis of Medicare patients with HF, Zhang and Baik (2014) found that in comparison to White patients, ethnic minority populations, including Black and Hispanic patients, were more likely to be nonadherent to common HF medications (i.e., beta-blockers, angiotensin-converting enzyme [ACE] inhibitors, and diuretics), which helps to explain their increased readmission rates, longer hospital stays and increased mortality (Bagchi, Esposito, Kim, Verdier, & Bencio, 2007; Wu, Moser, Chung, et al, 2008a). …”

Section: Medication Adherence In Heart Failurementioning

confidence: 99%

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Predictors of medication nonadherence differ among black and white patients with heart failure

2015

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Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.

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Section: Discussionsupporting

confidence: 88%

Section: Medication Adherence In Heart Failurementioning

confidence: 99%

Predictors of medication nonadherence differ among black and white patients with heart failure

2015

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“…Part D implementation has resulted in modest improvements in medications adherence as reported by Donohue et al 7 Zhang et al reported 52% of patients had good adherence for HF medications up to one year in a 5% sample of Medicare fee for-service beneficiaries with 1 inpatient or 2 outpatient claims for HF during 2007–2009. 5 Adherence to individual medications was not reported. In our study, short-term adherence rates for ARIC participants with PADC ≥80% in the first month were substantially higher but declined by 22–26% to similar rates by the end of the study, 63%, 60%, and 64% for BB, ACE-I, and diuretics, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…2–7, 9 In the few studies that have utilized Medicare Part D data, adherence has been described in patients with either an inpatient or outpatient HF claim. 4, 5, 7 However, no study using Medicare Part D data has examined adherence to HF-specific medications immediately after hospitalization. This issue is of significant policy interest since the Centers for Medicare and Medicaid Services (CMS) is now tying payment to readmission rates for some chronic diseases, including HF.…”

mentioning

confidence: 99%

Medication Adherence Based on Part D Claims for Patients With Heart Failure After Hospitalization (from the Atherosclerosis Risk in Communities Study)

Rodgers

Chang

Zhou

et al. 2015

The American Journal of Cardiology

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Medication non-adherence is a common precipitant of heart failure (HF) hospitalization and is associated with poor outcomes. Recent analyses of national data focus on long-term medication adherence. Little is known about adherence of HF patients immediately following hospitalization. Hospitalized HF patients were identified from the Atherosclerosis Risk in Communities (ARIC) study. ARIC data were linked to Medicare inpatient and Part D claims from 2006–2009. Inclusion criteria were: a chart adjudicated diagnosis of acute decompensated or chronic HF; documentation of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), beta-blocker (BB), or diuretic prescription at discharge; Medicare Part D coverage. Proportion ambulatory days covered (PADC) was calculated for up to twelve 30-day periods after discharge. Adherence was defined as ≥80% PADC. We identified 402 participants with Medicare Part D: mean age 75, 30% male, 41% black. Adherence at 1, 3 and 12 months was 70%, 61%, 53% for ACEI/ARB, 76%, 66%, 62% for BB, and 75%, 68%, 59% for diuretic. Adherence to any single drug class was positively correlated with being adherent to other classes. Adherence varied by geographic site/race for ACEI/ARB and BB but not diuretics. In conclusion, despite having Part D coverage, medication adherence post discharge for all three medication classes declined over 2–4 months after discharge, followed by a plateau over the subsequent year. Interventions should focus on early and sustained adherence.

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“…5–8 For example, in a study of outpatients with established coronary heart disease, non-adherent patients, defined as following prescribed medication directions less than 75% of the time, were found to be 2.3 more likely to have a CV event when compared to their adherent counterparts. 8 Patients from minority populations have higher than average rates of non-adherence and CV events, 9,10 making them an important priority for treatment improvement efforts. Accountability for medication adherence is shared by patients, clinicians, their health care team, and the health care system as a whole.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist intervention for blood pressure control: medication intensification and adherence

Gums

Uribe

Weg

et al. 2015

Journal of the American Society of Hypertension

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Objective To describe medication adherence and medication intensification in a physician-pharmacist collaborative management (PPCM) model compared to usual care. Design Prospective, cluster, randomized study in 32 primary care offices from 15 states. The primary outcomes were medication adherence and anti-hypertensive medication changes during the first nine months of the intervention. The nine month visit was completed by 539 patients, 345 of which received the intervention. Results There was no significant difference between intervention and usual care patients in regards to medication adherence at 9 months. Intervention patients received significantly more medication changes (4.9 vs.1.1; p=0.0003) and had significantly increased use of diuretics and aldosterone antagonists when compared to usual care (p=0.01). Conclusions The PPCM model increased medication intensification, however no significant change in medication adherence was detected. PPCM models will need to develop non-adherence identification and intervention methods to further improve the potency of the care team.

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Race/Ethnicity, Disability, and Medication Adherence Among Medicare Beneficiaries with Heart Failure

Cited by 73 publications

References 19 publications

Predictors of medication nonadherence differ among black and white patients with heart failure

Predictors of medication nonadherence differ among black and white patients with heart failure

Medication Adherence Based on Part D Claims for Patients With Heart Failure After Hospitalization (from the Atherosclerosis Risk in Communities Study)

Pharmacist intervention for blood pressure control: medication intensification and adherence

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