Providers' mediating role for medication adherence among cancer survivors
We conducted a mediation analysis of the provider team's role in changes to chronic condition medication adherence among cancer survivors. We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We...
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| Published in | PloS one Vol. 16; no. 11; p. e0260358 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
29.11.2021
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
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| Summary: | We conducted a mediation analysis of the provider team's role in changes to chronic condition medication adherence among cancer survivors.
We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We included beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for non-insulin anti-diabetics, statins, and/or anti-hypertensives and similar individuals without cancer from Surveillance, Epidemiology, and End Results-Medicare data, 2008-2014. Chronic condition medication adherence was defined as a proportion of days covered ≥ 80%. Provider team structure was measured using two factors capturing the number of providers seen and the historical amount of patient sharing among providers. Linear regressions relying on within-survivor variation were run separately for each cancer site, chronic condition, and follow-up period.
The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. Provider team effects were statistically insignificant in 13 of 17 analytic samples with significant changes in adherence. Statistically significant provider team effects were small in magnitude (<0.5 percentage points).
Increased complexity in the provider team associated with cancer diagnosis did not lead to meaningful reductions in medication adherence. Interventions aimed at improving chronic condition medication adherence should be targeted based on the type of cancer and chronic condition and focus on other provider, systemic, or patient factors. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Current address: Kaiser Family Foundation, San Francisco, California, United States of America Competing Interests: Dr. Lund’s spouse is a full-time, paid employee of GlaxoSmithKline who also holds stock in the amount of approximately $42,000. Dr. Lund also receives unrelated grant funding paid to her institution from AbbVie. Drs. Reeder-Hayes and Wheeler receive unrelated grant funding paid to their institution from Pfizer. Dr. Farley received unrelated grant funding paid to his institution from Astra Zeneca. All other co-authors have no potential conflicts of interest to report. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The SEER-Medicare data is owned by the SEER registry Principal Investigators and the Centers for Medicare and Medicaid Services. Although personal identifiers for all patient and medical care providers have been removed from the SEER-Medicare data, there remains the remote risk of re-identification (given the large amount of data available). Data can be accessed, subject to approval and data use agreement, from the Healthcare Delivery Research Program at the National Cancer Institute. This does not alter our adherence to PLOS ONE policies on sharing data and materials. |
| ISSN: | 1932-6203 1932-6203 |
| DOI: | 10.1371/journal.pone.0260358 |