The Association Between Diabetes Metabolic Control and Drug Adherence in an Indigent Population

Schectman, Joel M.; Nadkarni, Mohan; Voss, John D.

doi:10.2337/diacare.25.6.1015

Cited by 309 publications

(277 citation statements)

References 51 publications

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“…This was similar to racial differences in insulin self-management in an indigent population reported by Schectman et al (25). Additional outreach may be needed to African-American veterans to determine how the system can better serve them.…”

Section: Research Design Andsupporting

confidence: 60%

The Influence of Insulin Use on Glycemic Control

2005

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OBJECTIVE -The purposes of this study were to determine the relationship between insulin self-management and glycemic control and to identify patient characteristics associated with better control. RESEARCH DESIGN AND METHODS-A Department of Veterans Affairs regional database was used to identify patients with diabetes on chronic insulin therapy (n ϭ 6,222) with dose defined as number of units and doses. The rate of insulin use during a 2-year period was calculated using pharmacy data. Regression analyses were used 1) to predict compliance with prescribed insulin regimens using demographic variables, HbA 1c levels, and a measure of diabetes management intensity and 2) to predict HbA 1c levels using demographic variables and rates of insulin use.RESULTS -Insulin use was 77.44 Ϯ 17% of prescribed amounts, including wastage; HbA 1c levels were 7.98 Ϯ 1.66%. Concomitant oral hypoglycemic agent use (84.89 Ϯ 16%) was higher than insulin use (P Ͻ 0.0001) but correlated with insulin use (r ϭ 0.189, P Ͻ 0.0001). Ordinary least-squares regression showed that race, HbA 1c levels, and intensity of diabetes management were significant predictors of insulin use. Age, race, and insulin use were significant predictors of HbA 1c levels.CONCLUSIONS -Adults prescribed a specific insulin regimen averaged using 77% of prescribed doses, demonstrating good intention to follow the prescription. However, HbA 1c higher than the recommended level suggested that the rate of insulin use, the prescribed regimen, or both were inadequate to achieve good glycemic control in patients with long-term insulin use. Diabetes Care 28:78 -83, 2005

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Section: Research Design Andsupporting

confidence: 60%

The Influence of Insulin Use on Glycemic Control

2005

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“…Our estimate of a persistent racial gap in A1C is consistent with the findings of Schectman et al (13), who found evidence of a racial gap in A1C after controlling for medication adherence to oral medications. Our findings differ from those of Pladevall et al (12), who found no evidence of racial differences in glycemic control after controlling for adherence to metformin.…”

Section: Baseline Differences By Racesupporting

confidence: 82%

“…We used nonparametric tests (Kolmogorov-Smirnov) (19) to assess racial differences in the number of physician visits and the number of A1C tests. Median months of follow-up were similar for black (median 51 [minimum 13, maximum 108) and white patients (52 [13,108]). …”

Section: Discussionmentioning

confidence: 77%

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Medication Adherence and Racial Differences in A1C Control

et al. 2008

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OBJECTIVE -The purpose of this study was to examine medication adherence and other self-management practices as potential determinants of higher glycemic risk among black relative to white patients.RESEARCH DESIGN AND METHODS -We used a retrospective, longitudinal repeated-measures design to model the contribution of medication adherence to black-white differences in A1C among type 2 diabetic patients at a large multispecialty group practice. We identified 1,806 adult (aged Ն18 at diagnosis) patients (467 black and 1,339 white) with newly initiated oral hypoglycemic therapy between 1 December 1994 and 31 December 2000. Race was identified using an electronic medical record and patient self-report. Baseline was defined as the 13 months preceding and included the month of therapy initiation. All patients were required to have at least 12 months of follow-up.RESULTS -At initiation of therapy, black patients had higher average A1C values compared with whites (9.8 vs. 8.9, a difference of 0.88; P Ͻ 0.0001). Blacks had lower average medication adherence during the first year of therapy (72 vs. 78%; P Ͻ 0.0001). Although more frequent medication refills were associated with lower average A1C values, adjustment for adherence did not eliminate the black-white gap.CONCLUSIONS -We found persistent racial differences in A1C that were not explained by differences in medication adherence. Our findings suggest that targeting medication adherence alone is unlikely to reduce disparities in glycemic control in this setting. Further research is needed to explore possible genetic and environmental determinants of higher A1C among blacks at diagnosis, which may represent a critical period for more intensive intervention.

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“…Prior work in medication adherence shows that adherence rates may be lower for certain ethnic minorities. [26][27][28][29] Differences in health beliefs and use of alternative therapies may explain some differences found in adherence rates for special populations. [30][31][32] Replicating this study in special populations could yield novel and clinically useful results.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Patients’ Beliefs and Preferences Regarding Doctors’ Medication Recommendations

Goff

Mazor

Meterko³

et al. 2008

J GEN INTERN MED

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BACKGROUND: An estimated 20-50% of patients do not take medications as recommended. Accepting a doctor's recommendation is the first step in medication adherence, yet little is known about patients' beliefs and preferences about how medications are prescribed. OBJECTIVE:To explore patients' beliefs and preferences about medication prescribing to understand factors that might affect medication adherence. METHODS:Fifty members from 2 health plans in Massachusetts participated in in-depth telephone interviews. Participants listened to an audio-vignette of a doctor prescribing a medication to a patient and were asked a series of questions related to the vignette. Responses were reviewed in an iterative process to identify themes related to participants' beliefs and preferences about medication prescribing. RESULTS:Participants' beliefs and preferences about medication prescribing encompassed 3 major areas: patient-doctor relationships, outside influences, and professional expertise. Important findings included participants' concerns about the pharmaceutical industry's influence on doctors' prescribing practices and beliefs that there is a clear "best" medication for most health problems. CONCLUSIONS:Patients' beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors' relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.

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The Association Between Diabetes Metabolic Control and Drug Adherence in an Indigent Population

Cited by 309 publications

References 51 publications

The Influence of Insulin Use on Glycemic Control

The Influence of Insulin Use on Glycemic Control

Medication Adherence and Racial Differences in A1C Control

Patients’ Beliefs and Preferences Regarding Doctors’ Medication Recommendations

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