Pf Pace

Predictors of Medication Nonadherence Among Patients With Diabetes in Medicare Part D Programs: A Retrospective Cohort Study

OBJECTIVES This study examined the prevalence of nonadherence with oral hypoglycemic agents, antihypertensive drugs (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]), and statin medications among Medicare Part D enrollees with diabetes and analyzed the potential demographic and clinical factors that predict medication nonadherence. METHODS This was a retrospective cohort study of Medicare Part D enrollees with diabetes from 6 states (Alabama, California, Florida, Mississippi, New York, and Ohio). Adherence was calculated as the proportion of days covered (PDC; number of days with medication on hand/number of days in the specified time interval). A PDC was derived for each of the 3 categories of medications for patients who had at least 1 claim for the same class of medication. A comorbidity measure was created for each beneficiary using the Deyo-adapted Charlson Comorbidity Index (CCI). Associations between nonadherence and patient characteristics including age, sex, race/ethnicity, and Deyo-adapted CCI were examined. Logistic regression models were constructed to identify predictors of nonadherence. RESULTS The study included 1,888,682 patients with diabetes. The mean (SD) age was 71.6 (11.6) years, and 59.5% (1,123,220/1,888,682) were female. A total of 66.4% (1,254,538/1,888,682) were white, 16.3% (308,158/1,888,682) were black, and 7.8% (147,498/1,888,682) were Hispanic. Estimated rates of non-adherence for oral hypoglycemic agents, ACEIs/ARBs, and statins were 35.1% (386,666/1,101,533), 41.8% (449,561/1,075,285), and 46.4% (447,106/962,877), respectively. In unadjusted analyses, patients aged <65 years, women, black or Hispanic patients, and patients with higher Deyo-adapted CCI were more likely to be nonadherent to all 3 classes of medications. The results were consistent in multivariate analyses, and all results were statistically significant at P < 0.001. CONCLUSIONS In this study of Medicare Part D enrollees with diabetes, patients aged <65 years, women, black or Hispanic patients, and those with higher comorbidity scores were more likely to be nonadherent to medications. Interventions should be developed to improve medication adherence among these subgroups so that patients can achieve the full benefits of prescribed pharmacologic therapies.

Medication Adherence Among Recipients with Chronic Diseases Enrolled in a State Medicaid Program

Limited information is currently available about medication adherence for common chronic conditions among the Medicaid population. The primary objective of this study was to assess medication adherence among Medicaid recipients with depression, diabetes, epilepsy, hypercholesterolemia, and hypertension. Factors influencing adherence were determined. The authors also assessed whether adherence influences the utilization of acute care services. The target population included nonelderly adult recipients (ages 21-64 years) who were continuously enrolled in the Mississippi (MS) Medicaid fee-for-service program from January 1, 2006 to December 31, 2007. Recipients were identified who had a medical services claim with a diagnosis of depression, diabetes, epilepsy, hypercholesterolemia, or hypertension in calendar year 2006. Within each chronic disease sample, medication adherence was determined using calendar year 2007 data for recipients who met inclusion and exclusion criteria. Recipients with adherence ≥80% were classified as adherent. Logistic regression analyses were used to determine the factors that predict medication adherence and the effect of adherence on concurrent all-cause acute care service (ie, hospitalization, emergency room visit) utilization. Approximately 24% of recipients with depression, 35.9% with diabetes, 53.6% with epilepsy, 32% with hypercholesterolemia, and 42.2% with hypertension were adherent. Within each chronic disease sample, males and whites had higher adherence than females and blacks. After controlling for demographic and disease-related covariates, recipients who were adherent had lower concurrent acute care service utilization than nonadherent recipients. Given the inverse relationship between adherence and acute care service utilization, policy makers should consider implementing educational interventions aimed at improving adherence in this underprivileged population.

Nonadherence to angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers among high-risk patients with diabetes in Medicare Part D programs

OBJECTIVES To identify predictors of nonadherence to angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs) and to assess the association between nonadherence to ACEIs/ARBs and potentially avoidable hospitalizations (PAHs) among elderly high-risk patients with diabetes. METHODS Medicare Part D enrollees from six states who had diabetes and coexisting hypertension and/or renal disease, were aged 65 years or older, and who had filled at least one prescription for ACEIs/ARBs in the first 6 months of 2006 were included in this retrospective cohort study. The primary outcomes of interests were patient nonadherence to ACEI/ARB therapy, which was defined as a proportion of days covered (PDC) less than 0.8 and PAH for diabetes during the patient follow-up period (July 1, 2006, to March 31, 2007). RESULTS A total of 599,141 patients (mean [+/-SD] age 75.6 +/-7.3 years, 66% women, 63% white, 15% black, and 9% Hispanic) were included. Among them, 46% were nonadherent to ACEI/ARB therapy and 6.3% had a PAH during the follow-up period. In multivariate logistic regressions, patients with diabetes and both hypertension and renal disease and patients with diabetes and renal disease only were 24% and 15% more likely, respectively, to be nonadherent to ACEI/ARB therapy compared with patients with diabetes and hypertension. Black and Hispanic patients were also more likely to be nonadherent to ACEI/ARB therapy. Nonadherence to ACEI/ARB therapy was associated with a 5% increase in the likelihood of PAH. CONCLUSION Adherence to ACEI/ARB therapy is suboptimal among elderly high-risk patients with diabetes enrolled in Medicare Part D programs from six states, and nonadherence to ACEIs/ARBs is associated with a slightly increased risk for PAH.

High-risk Diabetic Patients in Medicare Part D Programs: Are They Getting the Recommended ACEI/ARB Therapy?

BACKGROUNDDiabetes patients with hypertension and/or renal disease are at an increased risk of cardiovascular morbidity and mortality. Clinical evidence suggests that the use of ACEI/ARB for these patients improves patient outcomes.OBJECTIVETo describe ACEI/ARB utilization among high-risk patients with diabetes and to identify patient characteristics that predict suboptimal utilization of ACEI/ARB.DESIGNA retrospective cohort study.PATIENTSDiabetic patients with coexisting hypertension and/or renal disease with continuous Medicare coverage from October 1, 2005 through June 30, 2006 in six states (Alabama, California, Florida, Mississippi, New York, and Ohio).INTERVENTIONS AND MEASUREMENTSAny ACEI/ARB use during the first 6 months of 2006.RESULTSA total of 1,250,466 Medicare Part D enrollees met our inclusion criteria. ACEI/ARB utilization rates were 63%, 58.3%, and 43.1% among diabetic patients with hypertension and renal disease, hypertension without renal disease, and renal involvement without hypertension, respectively. After adjusting for all other characteristics studied, patients in the hypertension only (OR 0.83; 95% CI: 0.82–0.84) and renal disease only (OR: 0.48; 95% CI: 0.46–0.50) risk groups were less likely to use ACEI/ARB compared to diabetes patients with both hypertension and renal disease. Several demographics, including male gender, age older than 65, and white race, were all predictors of suboptimal ACEI/ARB use. Results from state-specific analyses are consistent with those for all six states.CONCLUSIONIn this cohort, less than 60% of high-risk patients with diabetes were receiving the recommended ACEI/ARB therapy. Several patient demographic and clinical characteristics are strongly associated with suboptimal ACEI/ARB use.

A Microtiter Assay Shows Effectiveness of Fungicides for Control of Colletotrichum spp. from Strawberry

The anthracnose pathogens, Colletotrichum acutatum, C. gloeosporioides, and C. fragariae, have developed resistance to several fungicides. We used a microtiter assay to test in vitro the activity of 16 agrochemicals against 10 isolates of Colletotrichum spp. using a dose-response format. At a concentration of 30 μM, captan, thiram, cyprodinil, chlorothalonil, azoxystrobin, and kelthane provided nearly 100% inhibition of the growth of all 10 Colletotrichum isolates. Iprodione, vinclozolin, metalaxyl, and fosetyl-Al did not inhibit growth of any isolate. Benomyl and thiobendazole inhibited growth of the C. fragariae and C. gloeosporioides isolates, but did not inhibit growth of the six C. acutatum isolates. This article not subject to US copyright law. Patrick Page is currently affiliated with the School of Pharmacy, University of Southern Mississippi.

Development of the medication adherence estimation and differentiation scale (MEDS)

Abstract Objectives: To develop a self-reported measure for medication adherence and compare its ability to predict the proportion of days covered (PDC) with contemporary scales. Methods: Retrospective prescription fill data from three community pharmacies in the Southeastern US were assessed to identify patients that were 18 years of age or older, and had received at least one medication for diabetes, hypertension, or dyslipidemia. A cross-sectional survey containing the Medication adherence Estimation and Differentiation Scale (MEDS) was administered among these pharmacy patrons. The MEDS assessed the extent and reasons for non-adherence. Survey responses were anonymously linked with retrospective prescription fill data. A total of 685 patients were sampled. The proportion of days covered (PDC) was used as the criterion measure. The Morisky, Green, and Levine Adherence Scale (1986 Morisky scale) and the Medication Adherence Reasons Scale (MAR-Scale) were used as comparators. Results: The MEDS presented a five-factor solution—worries about side-effects, worries about addiction, worries about cost, lack of perceived need, and unintentional non-adherence (CFI = 0.97; RMSEA = 0.06; SRMR = 0.03; standardized factor loadings greater than 0.5, and statistically significant). The relationship between MEDS scores and PDC was statistically significant (unstandardized regression coefficient = –0.50, p < .01). The MEDS performed better than the 1986 Morisky scale (R2 = 0.02 vs 0.05, standardized regression coefficient = –0.13 vs –0.21) and the MAR-Scale (R2 = 0.02 vs 0.05, standardized regression coefficient = –0.12 vs –0.21) in predicting PDC. Conclusions: The MEDS demonstrated good psychometric properties and performed better than the comparator scales in the prediction of PDC.

PDB75 EFFECTS OF STATIN THERAPY ON HOSPITALIZATION AND MORTALITY IN PATIENTS WITH DIABETES: A RETROSPECTIVE COHORT STUDY

PDB75 EFFECTS OF STATIN THERAPY ON HOSPITALIZATION AND MORTALITY IN PATIENTS WITH DIABETES: A RETROSPECTIVE COHORT STUDY Yang Y, Banahan BF, Pace PF University of Mississippi, University, MS, USA, University of Mississippi, Oxford, MS, USA OBJECTIVES: Clinical practice guidelines suggest that to achieve greater reductions in cardiovascular risk, statin therapy should be prescribed for diabetic patients at earlier stages. The objective of this study was to assess the influence of statin therapy on diabetes-specific hospitalization and all-cause mortality in diabetic patients enrolled in a state Medicaid program. METHODS: This is a retrospective cohort study of patients with diabetes using Medicaid pharmacy and medical claims data. Patients aged 40 years or older with a diagnosis of diabetes, who had continuous coverage in a state Medicaid program from January 2002 to December 2004, and who had a diagnosis of diabetes in 2002 were included in the study and were followed up until December 2004. Statin therapy was measured in using pharmacy claims data of 2003 and statin use was defined as at least two filled prescriptions for statin medications in 2003. The primary outcomes of interest were diabetes-specific hospitalization and all-cause mortality in 2004. Multivariate regression analyses were performed to assess the impact of statin therapy on outcome measures. RESULTS: A total of 21,110 patients met our inclusion criteria. Among them, 76.6% were females and the mean age was 62.9 (± 12.3) years. Less than 30% (28.7%) were prescribed statin medications in 2003. After controlling for baseline patient characteristics including age, gender, race, prior hospitalization, comorbidities (measured using Charlson comorbidity index), and use of insulin, oral hypoglycemic agents, and antihypertensive medications, in comparison to non-users, statin users were 29.1% less likely to have diabetes-specific hospitalizations (OR: 0.719; 95%CI: 0.628–0.824). The odds for all-cause mortality were also lower in statin users as compared to non-users (OR: 0.480; 95%CI: 0.327–0.705). CONCLUSIONS: The results of this study show that statin use rate is low among adults enrolled in a Medicaid program. Statin therapy in adult diabetic patients reduces diabetes-specific hospitalizations and all-cause mortality.