Variations in compliance among hypertensive patients by drug class: implications for health care costs

Rizzo, John A.; Simons, WR

doi:10.1016/s0149-2918(97)80018-5

Cited by 147 publications

(113 citation statements)

References 18 publications

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“…4,[33][34][35] Switching and discontinuation have also been shown to increase the costs of hypertension. 32,34,36,37 Our study constitutes a 'real world' insight into persistence and utilization of health-care resources in a population-based clinical hypertension cohort. Nonetheless, results should be considered in light of the study limitations.…”

Section: Discussionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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The objective was to assess persistence with antihypertensive therapy (AHT) and discontinuation patterns in patients newly dispensed different antihypertensive drug classes in a natural Canadian population-based setting. Hypertensive patients initiating AHT monotherapy were included in this 3-year retrospective cohort study (N ¼ 21 326) using the Saskatchewan health-care databases. Persistence was defined as consistently refilling a new prescription for AHT within 90 days of a previous dispensing. New courses of AHT were also documented in nonpersistent patients. Kaplan-Meier and Cox regression analyses were used to compare persistence and new courses of therapy across initial drugs. Compared to the newer angiotensin II antagonists (AIIAs), the likelihood of discontinuing therapy over the 39-month study period was significantly higher for angiotensin-converting enzymes inhibitors (HR ¼ 1.29; 95% CI ¼ 1.16-1.43), calcium channel blockers (HR ¼ 1.42; 95% CI ¼ 1.27-1.60), beta blockers (HR ¼ 1.62; 95% CI ¼ 1.45-1.80) and diuretics (HR ¼ 1.92; 95% CI ¼ 1.73-2.14). In the year following treatment discontinuation, between 54 and 75% of patients initiated a second course of treatment. Patients initiated on an AIIA had a significantly higher likelihood of starting a new course of therapy after a first treatment discontinuation, compared to all other agents. In conclusion, hypertensive patients initiated on an AIIA not only had greater persistence to AHT but were also more likely to initiate a new course of AHT after discontinuation than those initiating treatment with other agents. Further studies are required that relate intermittent treatment behaviours to health outcomes and costs in hypertension.

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Section: Discussionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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“…To examine prescription refill compliance (referred to as "compliance"), a medication possession ratio (MPR), as defined by Rizzo and Simons (1997), 26 was calculated. This ratio is a measure of the amount of drug a patient may have had access…”

Section: Methodsmentioning

confidence: 99%

“…Persistence is the length of time medications continued to be refilled, and was defined as an MPR <0.30. This compliance and persistence methodology is based on previous work conducted by Rizzo and Simons (1997). 26 Compliance and persistence rates were based on the date the first prescription was filled in the study period and subsequent refill dates.…”

Section: Stimulant Treatment Patterns and Compliance In Children And mentioning

confidence: 99%

“…This compliance and persistence methodology is based on previous work conducted by Rizzo and Simons (1997). 26 Compliance and persistence rates were based on the date the first prescription was filled in the study period and subsequent refill dates. Therefore, it was possible that patients could have become more or less compliant at a later point within the 18-month follow-up period.…”

Section: Stimulant Treatment Patterns and Compliance In Children And mentioning

confidence: 99%

See 1 more Smart Citation

Stimulant Treatment Patterns and Compliance in Children and Adults With Newly Treated Attention-Deficit/Hyperactivity Disorder

Perwien¹,

Hall²,

Swensen³

et al. 2004

JMCP

124

109

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“…They generally include the choice of medication (7)(8)(9)(10)(11)(12)(13)(14)(15), some demographics (8,14,16,17) and health services factors (8,9). However, most studies focusing on this issue have looked at determinants of persistence (not compliance) (7,9,11,14,17) and most were secondary analyses of administrative databases (7)(8)(9)(10)(11)(12)(13)(14)(15)17). In these databases, important patient information, such as occupation, income, perception of health, and beliefs about the disease and its treatment, is seldom available.…”

Section: Clinical Studiesmentioning

confidence: 99%

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Grégoire

Moisan

Guibert

et al. 2006

Canadian Journal of Cardiology

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C ardiovascular disease remains the leading cause of mortality in the developed world. Despite evidence that blood pressure control may reduce premature cardiovascular mortality (1,2) and despite the availability of effective treatment for high blood pressure, a large proportion of identified hypertensive individuals do not have his or her blood pressure controlled (ie, diastolic blood pressure is greater than 90 mmHg or systolic blood pressure is greater than 140 mmgHg) (3-5).Poor adherence to the recommended drug regimen constitutes a major barrier to adequate control of high blood pressure (3). Three different aspects can be differentiated within the broader concept of adherence (6). The first aspect is acceptance, BACKGROUND: Persistence and compliance are different aspects of the broader concept of adherence to drug treatment. In a prior study, determinants of nonpersistence in a group of patients newly prescribed antihypertensive medications were examined. OBJECTIVE: To determine noncompliance among those who were persistent with therapy. METHODS: A prospective cohort study was conducted, in which individuals prescribed a new antihypertensive monotherapy were identified through a network of 173 pharmacies. Participants were interviewed by telephone twice during a three-month period. At the end of this period, individuals who reported still taking the medication initially prescribed were included in the analysis. Self-reported noncompliance was measured at three months. Data were analyzed using a multivariate logistic regression model. RESULTS: Of 509 eligible participants, 118 (23.2%) reported noncompliance with their drug treatment. Noncompliance was significantly associated with the use of angiotensin-converting enzyme inhibitors (adjusted OR [AOR] 3.0; 95% CI 1.17 to 7.92) compared with the angiotensin II receptor blocker losartan, and with the belief that hypertension is not a risk factor for cardiovascular diseases (AOR 2.0; 95% CI 1.21 to 3.33). On the other hand, noncompliance was inversely associated with the use of more than four pills of medication per day (AOR 0.3; 95% CI 0.15 to 0.64). CONCLUSIONS: Compliance with drug treatment could be improved by proper selection of medication, and by attempts to correct the false perceptions patients may have about hypertension. Further research is needed to better understand the clinical significance of a higher number of pills as a predictor of good compliance. Further research is also needed using different means of measuring noncompliance.

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Variations in compliance among hypertensive patients by drug class: implications for health care costs

Cited by 147 publications

References 18 publications

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

Stimulant Treatment Patterns and Compliance in Children and Adults With Newly Treated Attention-Deficit/Hyperactivity Disorder

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

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