Trends in Antihypertensive Medication Discontinuation and Low Adherence Among Medicare Beneficiaries Initiating Treatment From 2007 to 2012
Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating...
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Published in | Hypertension (Dallas, Tex. 1979) Vol. 68; no. 3; pp. 565 - 575 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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United States
American Heart Association, Inc
01.09.2016
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Subjects | |
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Abstract | Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days after initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days after initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41 135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable during the study period (21.0% in 2007 and 21.3% in 2012; P-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (P-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval, 0.83–0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries; however, rates of discontinuation and low adherence remain high. |
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AbstractList | Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days after initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days after initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41 135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable during the study period (21.0% in 2007 and 21.3% in 2012; P-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (P-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval, 0.83–0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries; however, rates of discontinuation and low adherence remain high. Low antihypertensive medication adherence is common. Over recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days following initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days following initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41,135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable over the study period (21.0% in 2007 and 21.3% in 2012; p-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (p-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval 0.83–0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90 day prescription fill, with dementia, a history of stroke, and those who reached the Medicare part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries however rates of discontinuation and low adherence remain high. Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days after initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days after initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41 135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable during the study period (21.0% in 2007 and 21.3% in 2012; P -trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 ( P -trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval, 0.83–0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries; however, rates of discontinuation and low adherence remain high. |
Author | Muntner, Paul Kronish, Ian M Huang, Lei Shimbo, Daichi Krousel-Wood, Marie Bress, Adam P Tajeu, Gabriel S Kent, Shia T |
AuthorAffiliation | From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.) |
AuthorAffiliation_xml | – name: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.) – name: 3 Department of Medicine, Tulane University School of Medicine; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine; Research Division, Ochsner Clinic Foundation, New Orleans, Louisiana – name: 1 Department of Epidemiology, University of Alabama at Birmingham – name: 4 Department of Pharmacotherapy, University of Utah – name: 2 Center for Behavioral Cardiovascular Health, Columbia University Medical Center |
Author_xml | – sequence: 1 givenname: Gabriel surname: Tajeu middlename: S fullname: Tajeu, Gabriel S organization: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.) – sequence: 2 givenname: Shia surname: Kent middlename: T fullname: Kent, Shia T – sequence: 3 givenname: Ian surname: Kronish middlename: M fullname: Kronish, Ian M – sequence: 4 givenname: Lei surname: Huang fullname: Huang, Lei – sequence: 5 givenname: Marie surname: Krousel-Wood fullname: Krousel-Wood, Marie – sequence: 6 givenname: Adam surname: Bress middlename: P fullname: Bress, Adam P – sequence: 7 givenname: Daichi surname: Shimbo fullname: Shimbo, Daichi – sequence: 8 givenname: Paul surname: Muntner fullname: Muntner, Paul |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27432867$$D View this record in MEDLINE/PubMed |
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References_xml | – ident: e_1_3_3_9_2 doi: 10.1016/j.jval.2013.03.1631 – ident: e_1_3_3_23_2 doi: 10.1097/HMR.0000000000000034 – ident: e_1_3_3_32_2 doi: 10.1177/0145721707308407 – volume: 15 start-page: 457 year: 2009 ident: e_1_3_3_14_2 article-title: Measuring concurrent adherence to multiple related medications. publication-title: Am J Manag Care contributor: fullname: Choudhry NK – ident: e_1_3_3_13_2 doi: 10.1097/MLR.0b013e31829b1d2a – ident: e_1_3_3_26_2 doi: 10.1377/hlthaff.27.1.103 – ident: e_1_3_3_29_2 doi: 10.1007/s12160-011-9342-5 – volume: 11 start-page: CD000011 year: 2014 ident: e_1_3_3_12_2 article-title: Interventions for enhancing medication adherence. publication-title: Cochrane Database Syst Rev contributor: fullname: Nieuwlaat R – ident: e_1_3_3_16_2 doi: 10.1001/jama.297.2.177 – ident: e_1_3_3_41_2 doi: 10.1007/s12160-012-9355-8 – ident: e_1_3_3_11_2 doi: 10.2146/ajhp090656 – ident: e_1_3_3_33_2 doi: 10.1016/j.mcna.2009.02.007 – start-page: 1 year: 2012 ident: e_1_3_3_42_2 article-title: Health characteristics of medicare traditional fee-for-service and medicare advantage enrollees: 1999–2004 national health and nutrition examination survey linked to 2007 medicare data. publication-title: Natl Health Stat Report contributor: fullname: Mirel LB – ident: e_1_3_3_36_2 doi: 10.1001/jama.2016.7050 – ident: e_1_3_3_20_2 doi: 10.1345/aph.1E594 – ident: e_1_3_3_7_2 doi: 10.1111/j.1751-7176.2010.00356.x – ident: e_1_3_3_24_2 doi: 10.1007/s11606-007-0385-z – volume: 4 start-page: 95 year: 2011 ident: e_1_3_3_31_2 article-title: Recent trends in the dispensing of 90-day-supply prescriptions at retail pharmacies: implications for improved convenience and access. publication-title: Am Health Drug Benefits contributor: fullname: Liberman JN – ident: e_1_3_3_15_2 doi: 10.1016/j.jash.2012.02.004 – ident: e_1_3_3_17_2 doi: 10.1161/CIRCULATIONAHA.110.983874 – ident: e_1_3_3_8_2 doi: 10.1111/j.1547-5069.2003.tb00001.x – ident: e_1_3_3_27_2 doi: 10.1377/hlthaff.2010.0571 – volume-title: 2014 national healthcare quality and disparities report year: 2015 ident: e_1_3_3_22_2 contributor: fullname: Agency for Healthcare Research and Quality – ident: e_1_3_3_28_2 doi: 10.1111/j.1524-6175.2007.06372.x – volume-title: The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure year: 2004 ident: e_1_3_3_10_2 contributor: fullname: The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure – ident: e_1_3_3_25_2 doi: 10.1111/j.1532-5415.2012.04037.x – ident: e_1_3_3_39_2 doi: 10.1053/j.ajkd.2010.02.348 – ident: e_1_3_3_21_2 doi: 10.1097/MLR.0b013e31819a5acc – volume-title: Prescription drug cost-sharing and antihypertensive drug access among state medicaid fee for service plans year: 2013 ident: e_1_3_3_34_2 contributor: fullname: National Center for Chronic Disease Prevention and Health Promotion – ident: e_1_3_3_40_2 doi: 10.3275/8475 – ident: e_1_3_3_18_2 doi: 10.2147/PPA.S29549 – volume: 9 start-page: CD007146 year: 2012 ident: e_1_3_3_38_2 article-title: Interventions for preventing falls in older people living in the community. publication-title: Cochrane Database Syst Rev contributor: fullname: Gillespie LD – ident: e_1_3_3_30_2 doi: 10.3122/jabfm.2007.01.060094 – ident: e_1_3_3_6_2 doi: 10.1001/archinte.1980.00330210028018 – ident: e_1_3_3_2_2 doi: 10.1161/CIR.0000000000000152 – ident: e_1_3_3_4_2 doi: 10.1161/CIRCULATIONAHA.108.768986 – ident: e_1_3_3_3_2 doi: 10.1161/HYPERTENSIONAHA.114.04012 – ident: e_1_3_3_35_2 doi: 10.1093/eurheartj/eht464 – ident: e_1_3_3_43_2 doi: 10.1002/pds.3361 – ident: e_1_3_3_19_2 doi: 10.1016/j.jpsychores.2007.05.004 – ident: e_1_3_3_37_2 doi: 10.1056/NEJMoa1511939 – ident: e_1_3_3_5_2 doi: 10.1016/j.amjhyper.2006.04.006 |
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Snippet | Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs... Low antihypertensive medication adherence is common. Over recent years, the impact of low medication adherence on increased morbidity and healthcare costs has... |
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SubjectTerms | Age Factors Aged Aged, 80 and over Antihypertensive Agents - therapeutic use Cohort Studies Ethnicity Female Humans Hypertension - diagnosis Hypertension - drug therapy Hypertension - epidemiology Male Medicare - statistics & numerical data Medication Adherence - ethnology Medication Adherence - statistics & numerical data Needs Assessment Patient Compliance - statistics & numerical data Poisson Distribution Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Socioeconomic Factors United States |
Title | Trends in Antihypertensive Medication Discontinuation and Low Adherence Among Medicare Beneficiaries Initiating Treatment From 2007 to 2012 |
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