Jamie C. Barner

Factors Associated With Adherence to Self-Monitoring of Blood Glucose Among Persons With Diabetes

PURPOSE The purpose of this study was to investigate the relationship between demographic, biological, and psychosocial characteristics of self-monitoring of blood glucose (SMBG) among people with diabetes. METHODS A total of 933 adults with diabetes were invited to participate in the study. A self-administered survey was used to address the study objective. Adherence to SMBG was assessed by comparing the number of glucose tests performed by the patient with the number recommended by the healthcare provider. Multivariate logistic regression analysis was used to assess the relationship among the variables. RESULTS Adherence to SMBG was 52%. Approximately one third of the participants (n = 213) could be categorized as adherent to SMBG. Multivariate logistic regression analysis revealed that study participants with type 1 diabetes who experienced fewer environmental barriers (e.g., lifestyle interference, inconvenience, painfulness, and cost) were significantly more adherent to SMBG (P < .05). CONCLUSIONS Adherence to SMBG was suboptimal. The most significant factors that interfered with adherence were having type 2 diabetes and environmental barriers. Knowing the importance of these factors may assist diabetes educators and other healthcare professionals in identifying people at risk for low adherence to SMBG and potentially long-term health complications.

Assessment of Adherence Measures with Different Stimulants Among Children and Adolescents

Study Objective. To examine adherence measures with different stimulants in children and adolescents.

Temporal Relationship between Use of NSAIDs, Including Selective COX-2 Inhibitors, and Cardiovascular Risk

AbstractBackground and Objective: The search for NSAIDs with less gastrointestinal toxicity led to the introduction of the selective cyclo-oxygenase-2 (COX-2) inhibitors. However, following their introduction into the market, concerns have developed regarding their safety, particularly their cardiovascular safety. The purpose of this study was to assess the cardiovascular risk (events included were myocardial infarction, stroke and myocardial infarction-related deaths) associated with long-term (>180 days of exposure) and short-term (≤180 days of exposure) use of non-selective NSAIDs, including ‘preferential COX-2 inhibitors’ (i.e. etodolac, nabumetone and salsalate), and selective COX-2 inhibitors. Methods: A retrospective analysis of the Veterans Integrated Service Network 17 Veterans Affairs (VA) database was conducted. Medicare data and Texas Department of Health mortality data were incorporated to capture events occurring outside the VA healthcare network. Patients ≥35 years of age who received celecoxib, rofecoxib, ibuprofen, etodolac and naproxen from 1 January 1999 through 31 December 2001, were included. Multivariate Cox proportional hazard models were used to analyse the relationship between cardiovascular risk and NSAID use, including selective COX-2 inhibitor use, while adjusting for various risk factors. Results: We identified 12 188 exposure periods (11 930 persons) and 146 cardiovascular events over the entire study period. Compared with long-term ibuprofen use, long-term use of celecoxib (adjusted hazard ratio [HR] 3.64; 95% CI 1.36, 9.70) and rofecoxib (adjusted HR 6.64; 95% CI 2.17, 20.28) was associated with a significant increase in cardiovascular risk. When restricted to patients ≥65 years of age, the cardiovascular risks associated with long-term celecoxib (adjusted HR 7.36; 95% CI 1.62, 33.48) and rofecoxib (adjusted HR 13.24; 95% CI 2.59, 67.68) use increased. Short-term use of celecoxib (adjusted HR 0.75; 95% CI 0.42, 1.35) and rofecoxib (adjusted HR 0.85; 95% CI 0.39, 1.86) was not associated with any significant change in cardiovascular risk when compared with short-term ibuprofen use. Neither long- nor short-term exposure to naproxen and etodolac was associated with cardionegative or cardioprotective effects when compared with ibuprofen use. Conclusions: The findings of this observational study, along with recent clinical trial results, suggest that prolonged exposure to selective COX-2 inhibitors may be associated with an increased risk of adverse cardiovascular outcomes.

Patient Adherence and Reimbursement Amount for Antidiabetic Fixed-Dose Combination Products Compared with Dual Therapy Among Texas Medicaid Recipients

BACKGROUND Little is known about the potential for improved adherence with and cost savings of fixed-dose combination therapy (FDCT) products compared with analogous dual therapy for type 2 diabetes mellitus. OBJECTIVES The objectives of this study were as follows: (1) to describe patient adherence to various oral antidiabetic regimens (ie, dual therapy and FDCT); (2) to determine whether there is a difference in medication adherence between FDCT users and analogous dual-therapy users; and (3) to assess whether there is a difference in reimbursement amounts between an FDCT product and its individual components. METHODS This study was a retrospective cohort analysis using the Texas Medicaid prescription claims database. The study subjects included those who used antidiabetic FDCT or dual therapy from August 1, 2000, to July 31, 2004. The identification period of study subjects was between August 1, 2000, and July 31, 2004, including 12 months before and after the index date, so that the overall time frame was from August 1, 1999, through July 31, 2005. Prescription claims were analyzed over a 12-month preindex and 12-month postindex period. Adherence was measured using medication possession ratio (MPR), and regimen costs per tablet were assessed utilizing the index prescription. RESULTS Overall, 7570 FDCT users and 14,762 dual-therapy users were identified. Regarding the postindex period, FDCT users had 1.8% higher MPR compared with dual-therapy users (78.6% vs 77.2%). Patients who switched from monotherapy to FDCT had a 1.5% decrease in adherence (from 79.7% to 78.5%), whereas those who switched from monotherapy to dual therapy had a 10.0% decrease in adherence (from 83.0% to 74.7%). Those who switched from dual therapy to FDCT had a 12.4% increase in adherence (from 72.7% to 81.7%). Multivariate logistic regression analyses revealed that among preindex monotherapy users, FDCT users were significantly more likely to have higher adherence than dual-therapy users (odds ratio [OR] = 1.867; 95% CI, 1.716-2.032) after controlling for covariates, and the results were similar among preindex dual-therapy users (OR = 1.551; 95% CI, 1.204-1.999). From the perspective of the third-party payer, all FDCT products were significantly less expensive than their equivalent individual components (P < 0.001). CONCLUSIONS Among these Texas Medicaid beneficiaries, antidiabetic FDCT users were more adherent to their regimen than dual-therapy users, and FDCT was less expensive than the analogous dual therapy. Because multiple agents are often required to achieve adequate glycemic control, it may be clinically and economically beneficial to treat eligible patients with FDCT products.

Assessing Barriers to Medication Adherence in Underserved Patients With Diabetes in Texas

Purpose The purpose of this study was to assess (1) medication adherence in individuals with diabetes, (2) barriers to adherence, and (3) what factors were related to medication nonadherence. Methods A self-administered anonymous survey was provided to adults with diabetes (N = 59) who used a grocery store chain pharmacy or a community clinic for the underserved. Participants were recruited by pharmacy staff to complete a 10- to 15-minute survey to assess adherence, access, barriers, medication use, and demographics. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS), which is a reliable and valid self-report adherence instrument. Access (eg, use medications from Mexico, transportation), barriers (eg, cost, language difficulties), medication use (eg, complementary and alternative medicine, prescription medication), and demographics were also measured. The survey was available in English and Spanish. Data collection occurred from December 2010 through February 2011. Results Fifty-nine participants completed the survey. Approximately 57% of study participants were male, 85% were Hispanic, and the mean age was 50.4 ± 10.3 years. Over 50% of participants had hypertension or dyslipidemia and were taking 3 or more medications. Participants (52.6%) reported their health status as good or excellent and over one-half (56%) of the participants were nonadherent (score 0-6). The following factors were significantly (P < .05) related to nonadherence: cost, no refills, poor health status, fewer disease states, and any reason. Conclusions This study increased awareness of barriers to medication adherence in a predominantly Hispanic underserved patient population. This may lead to more informed recommendations and perhaps address gaps in health disparities.

ADHD medication use, adherence, persistence and cost among Texas Medicaid children

Abstract Objectives: (1) Describe ADHD medication use, adherence and persistence. (2) Determine factors (e.g., medication type, demographics, concomitant medication use) associated with ADHD medication adherence and persistence. (3) Compare ADHD medication costs. Methods: Continuously enrolled Texas Medicaid children (3–18 years) with ≥2 ADHD prescription claims (July 2002–December 2008) were included. Prescription claims were grouped by medication type (i.e., immediate-release, extended-release, prodrug, non-stimulant); medication class (i.e., stimulant, non-stimulant); and duration of action (i.e., long-acting, short-acting). Adherence, using medication possession ratio, was measured continuously and dichotomously (80% cut-off). Persistence was days of continuous therapy without a 30-day gap and medication costs were reimbursement amount paid to dispensing pharmacies. Results: The study sample (n = 62,789) was primarily 6–12 years (61.7%) and male (69.2%). The majority of the subjects were prescribed extended-release agents (70.3%), stimulant agents (86.4%), and long-acting agents (84.5%). Adherence and persistence (adherence mean ± SD; adherence dichotomous; persistence mean ± SD) varied among medication type and was highest for non-stimulants (52.5 ± 30.9; 25.8%; 153.3 ± 124.3), followed by extended-release stimulants (52.1 ± 30.2; 24.1%; 143.7 ± 120.8), prodrug stimulants (47.6 ± 30.9; 21.1%; 113.3 ± 100.5) and immediate-release stimulants (37.2 ± 27.1; 9.8%; 95.4 ± 92.6). Logistic regression showed immediate-release stimulant users were 67% less adherent than non-stimulant users (p < 0.0001) and linear regression showed immediate-release, extended-release and long-acting users (p < 0.0001) were significantly less persistent than non-stimulant users. Females, increase in total number of medications, and comorbid medications were associated with better adherence and persistence. Non-stimulant agents (

Impact of telephone medication therapy management on medication and health-related problems, medication adherence, and medicare part D drug costs: A 6-month follow up

4.04 ± 

Texas pharmacists' opinions about and plans for provision of medication therapy management services

2.15) had the highest mean medication cost per patient per day and immediate-release stimulants had the lowest (

Pharmaceutical Care Certificate Program: Assessment of Pharmacists' Implementation into Practice

1.24 ± 

Development and implementation of a telephone medication therapy management program for Medicare beneficiaries

0.97). Conclusions: ADHD medication adherence and persistence was suboptimal. Although there was no difference in adherence between long-acting stimulant and non-stimulant users, non-stimulant users were more persistent compared to stimulant users. This study was limited due to the use of retrospective prescription claims data, which cannot capture actual patient use patterns, ICD-9 diagnoses, family history and support, or side effect profiles. Because ADHD can be effectively treated with pharmacotherapy, providers should be proactive in identifying patients with poor adherence and intervene to address barriers to medication adherence and persistence.