Why Don’t Diabetes Patients Achieve Recommended Risk Factor Targets? Poor Adherence versus Lack of Treatment Intensification

Abstract

Both nonadherence and lack of treatment intensification occur frequently in patients above target for CVD risk factor levels; however, lack of therapy intensification was somewhat more common. Quality improvement efforts should focus on these modifiable barriers to CVD risk factor control.

Aliskiren for Geriatric Lowering of Systolic Hypertension: a randomized controlled trial

“…30,31 Although this study was not designed to compare responses between age or race groups, the changes in msSBP at the 12-week end point induced by aliskiren and ramipril were numerically similar in the o75 and X75 years of age groups. Likewise the decreases in msSBP appeared to be similar in black and white patients although the low number of black patients enrolled in this study precludes a firm conclusion.…”

Adherence to Multiple Medications Prescribed for a Chronic Disease: A Methodological Investigation

“…10 Similarly, drug class adherence, measured by continuous measure of medication gaps, was combined into a single estimate for all medications for a chronic disease; the summary measure was computed by weighting the estimate for each class by the number of days from the first to last fill in the observation period and then the single estimate was dichotomized. 11 Martin et al (2009) presented a definition of PDC that the authors contended to have occurred because of therapeutic augmentation. 12 The conservative variant of the definition is appropriate if it is believed that all medications are required as prescribed in order to elicit desired therapeutic effects.…”

Missed Opportunities in Diabetes Management: A Longitudinal Assessment of Factors Associated with Sub-optimal Quality

“…This is the definition of intensification commonly accepted in the literature. [11][12][13] We identified a "failure to intensify therapy" if during a quarter where risk factor control was deemed "actionable," (A1c>8%, SBP≥140 mmHg, or LDL≥130 mg/dl), but no corresponding intensification occurred.…”