Abstract P173: Improvements in Adherence to Antihypertensive Medication Among Medicare Beneficiaries Initiating Treatment Between 2007 and 2012

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Shia T Kent ◽  
Daichi Shimbo ◽  
Marie Krousel-Wood ◽  
Ian M Kronish ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Low Income ◽  
Antihypertensive Medication ◽  
Pharmacy Claim ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Proportion Of Days Covered ◽  
Service Coverage ◽  
Multivariable Adjustment ◽  
Over Time

Introduction: Low antihypertensive medication adherence has been reported, leading to recommendations for interventions to improve adherence. We evaluated trends in low medication adherence and discontinuation among Medicare beneficiaries initiating antihypertensive medication from 2007 to 2012. Hypothesis: Low antihypertensive medication adherence has decreased over time. Methods: We analyzed data on beneficiaries with ≥ 2 diagnoses for hypertension (ICD-9, 401.xx) in the Medicare 5% random sample initiating antihypertensive medication. Initiation was defined by a pharmacy claim for antihypertensive medication with no claims within the previous 365 days. Beneficiaries were required to have full Medicare fee-for-service coverage (Parts A, B and D) for the 365 days prior to and following the date of initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 day following initiation. Discontinuation was defined as having no days of supply or fills during the final 73 days in the year following initiation. Results: Between 2007-2012, 44,147 Medicare beneficiaries initiated antihypertensive medication. In the overall sample, low adherence decreased from 36.4% in 2007 to 31.7% in 2012 (p<0.001) (Table). After multivariable adjustment, the relative risk (RR) of low adherence for beneficiaries initiating treatment in 2012 compared with those initiating treatment in 2007 was 0.84 (95% CI 0.79-0.89). Throughout the study period, low adherence was more common in beneficiaries that were black (RR 1.41; 95% CI 1.35-1.48), Hispanic (RR 1.40; 95% CI 1.30-1.50), had low income (RR 1.19; 95% CI 1.08-1.32), depression (RR 1.06; 95% CI 1.01-1.12), or a serious fall injury following antihypertensive medication initiation (RR 1.34; 95% CI 1.23-1.47). Discontinuation did not decrease over time. Conclusion: Low adherence to antihypertensive medication among Medicare beneficiaries has decreased over time. Higher rates of low adherence remain for blacks compared with whites.

Abstract P178: Trends in Antihypertensive Medication Nonadherence Among US Adults With Commercial Health Insurance Initiating Treatment Between 2007 and 2014

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Gabriel Tajeu ◽  
Shia T Kent ◽  
Lei Huang ◽  
Daichi Shimbo ◽  
Marie Krousel-Wood ◽  
...  
Keyword(s):  
Antihypertensive Medication ◽  
Loop Diuretic ◽  
Claims Data ◽  
Insurance Coverage ◽  
Angiotensin Receptor ◽  
Medication Nonadherence ◽  
Younger Adults ◽  
Proportion Of Days Covered ◽  
Commercial Health Insurance ◽  
Multivariable Adjustment

Introduction: Nonadherence to antihypertensive medication is common and associated with cardiovascular disease events. A previous study reported improvements in antihypertensive medication adherence among adults ≥65 years of age. It is unclear if this trend has also occurred among younger adults. Methods: Changes in antihypertensive medication nonadherence were calculated among commercially-insured US adults <65 years of age initiating treatment from 2007 to 2014 using MarketScan claims data. We required beneficiaries have ≥2 diagnoses for hypertension (ICD-9, 401.xx) and insurance coverage for 365 days prior to and following antihypertensive medication initiation. Initiation was defined by a pharmacy claim for antihypertensive medication with no claims for medication within the previous 365 days. During the 365 days after initiation, nonadherence was defined as having a proportion of days covered <80%. Results: The percentage of patients who were nonadherent to their antihypertensive medication was 55.6% in 2007 and 54.1% in 2014 (p-trend<0.001) ( Table ). After multivariable adjustment, the relative risk (RR) of nonadherence in 2014 compared with 2007 was 0.98 (95% CI 0.96-0.99). Risk for nonadherence was lower at older age (RR 0.73, 95% CI 0.71-0.74 comparing adults 55-64 to <25 years of age). Nonadherence was more common among adults that were female versus male (RR 1.05; 95% CI 1.05-1.06), initiated treatment with a loop diuretic (RR 1.26; 95% CI 1.24-1.28), had diabetes (RR 1.11; 95% CI 1.10-1.12), or experienced a serious fall injury after medication initiation (RR 1.10; 95% CI 1.06-1.15), and less common among adults initiating treatment with an angiotensin receptor blocker (RR 0.96; 95% CI 0.95-0.96), multiclass regimen (RR 0.89; 95% CI 0.88-0.90), receiving 90-day fills (RR 0.73; 95% CI 0.73-0.74), or medications by mail (RR 0.92; 95% CI 0.91-0.93). Conclusion: Among adults <65 years of age, nonadherence to antihypertensive medication did not meaningfully decrease between 2007 and 2014.

scholarly journals Effects of Medicare Drug Subsidies on Adherence for Diabetics: Evidence From a Regression Discontinuity Design

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Alexandra Glynn ◽  
Inmaculada Hernandez ◽  
Eric Roberts
Keyword(s):  
Medication Adherence ◽  
Low Income ◽  
Regression Discontinuity ◽  
Drug Costs ◽  
Financial Strain ◽  
Medicare Beneficiaries ◽  
Poverty Level ◽  
Improve Medication Adherence ◽  
Part D ◽  
Out Of Pocket Costs

Abstract Out-of-pocket prescription drug costs are rapidly rising, particularly for insulin, which is a life-saving drug used by 3.1 million diabetics on Medicare. High out-of-pocket costs place an accentuated financial strain on older adults with diabetes, many of whom have low incomes, and may impede medication adherence, leading to poor health outcomes. The Medicare Part D Low-Income Subsidy (LIS) program limits drug co-pays to under $8.50 per prescription and caps out-of-pocket drug costs for lowest-income recipients (&lt;135% Federal Poverty Level, FPL), resulting in pronounced differences in out-of-pocket costs for those with marginally different incomes. Using detailed income data from the Health and Retirement Study linked to Medicare claims (2008-2016), we employed a regression discontinuity (RD) design to isolate the effects of differences in out-of-pocket costs at eligibility thresholds for the LIS. Diabetic beneficiaries whose income exceeded the LIS eligibility threshold had lower Part D spending (-$945/year, p=0.03, n=2,367) and adherence to oral antidiabetic drugs (-8%, p=0.02). We conducted secondary analyses at the eligibility threshold for Medicaid, as individuals whose income exceeds the eligibility limit for Medicaid (100% of FPL in most states) are significantly less likely to receive the LIS. Above the Medicaid eligibility threshold (n=2,295), annual spending on insulin was $395 lower (p=0.002) and proportion of insulin use was 6% lower (p=0.04). These results suggest low-income Medicare beneficiaries who are not shielded from out-of-pocket costs via the LIS are particularly sensitive to drug costs. Policy proposals to limit out-of-pocket costs could improve medication adherence to high-cost drugs for vulnerable beneficiaries.

scholarly journals Persistence of High-Need Status Over Time Among Fee-for-Service Medicare Beneficiaries

2020 ◽  
pp. 107755871990121
Author(s):  
Tamra Keeney ◽  
Nina R. Joyce ◽  
David J. Meyers ◽  
Vincent Mor ◽  
Emmanuelle Belanger
Keyword(s):  
Claims Data ◽  
National Level ◽  
Demographic Characteristics ◽  
Administrative Claims ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Longitudinal Patterns ◽  
Poor Outcomes ◽  
Longitudinal Variability ◽  
Over Time

Although administrative claims data can be used to identify high-need (HN) Medicare beneficiaries, persistence in HN status among beneficiaries and subsequent variation in outcomes are unknown. We use national-level claims data to classify Fee-for-Service (FFS) Medicare beneficiaries as HN annually among beneficiaries continuously enrolled between 2013 and 2015. To examine persistence of HN status over time, we categorize longitudinal patterns in HN status into being never, newly, transiently, and persistently HN and examine differences in patients’ demographic characteristics and outcomes. Among survivors, 23% of beneficiaries were HN at any time—4% persistently HN, 13% transiently HN, and 6% newly HN. While beneficiaries who were persistently HN had higher mortality, utilization, and expenditures, classification as HN at any time was associated with poor outcomes. These findings demonstrate longitudinal variability of HN status among FFS beneficiaries and reveal the pervasiveness of poor outcomes associated with even transitory HN status over time.

scholarly journals Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension

Hypertension ◽  
2021 ◽  
Vol 77 (4) ◽  
pp. 1341-1349
Author(s):  
Hokyou Lee ◽  
Yuichiro Yano ◽  
So Mi Jemma Cho ◽  
Ji Eun Heo ◽  
Dong-Wook Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Medication Adherence ◽  
High Blood Pressure ◽  
Pharmacological Treatment ◽  
Cardiovascular Events ◽  
Antihypertensive Medication ◽  
Incidence Rates ◽  
Cvd Risk ◽  
Proportion Of Days Covered

Treatment and control rates for high blood pressure are unsatisfactory in young adults. Adherence to pharmacological treatment is alarmingly low, with absence of data on its consequences in young adults with hypertension. We investigated the association of antihypertensive medication nonadherence with incident cardiovascular events among young adults initiating pharmacological treatment for hypertension. From a nationwide health insurance database, we included 123 390 participants (75.1% male) of age 20 to 44 years, free of prior cardiovascular disease (CVD), who initiated pharmacological treatment for hypertension from 2004 through 2007. Participants were categorized as either adherent (proportion of days covered ≥0.8; n=45 350) or nonadherent (proportion of days covered <0.8; n=78 040) to antihypertensive medication during the first year of treatment. The primary outcome was composite CVD events, including myocardial infarction, stroke, heart failure, and cardiovascular death. Over a median follow-up of 10 years, 3002 new CVD events occurred. CVD incidence rates per 100 000 person-years were 191.0 in the adherent group and 282.1 in the nonadherent group. Multivariable-adjusted hazard ratio for CVD events associated with nonadherence versus adherence was 1.57 (95% CI, 1.45–1.71). There was a dose-response association between medication adherence (in quartiles or continuous proportion of days covered) and CVD risk. In conclusion, among young adults who initiated pharmacological treatment for high blood pressure, poor medication adherence was associated with higher risk for future CVD events.

scholarly journals PNS105 ASSOCIATION OF LOW-INCOME SUBSIDY/DUAL ELIGIBILITY AND DISABILITY WITH HIGH-RISK MEDICATION USE AMONG PART D MEDICARE BENEFICIARIES

2020 ◽  
Vol 23 ◽  
pp. S303
Author(s):  
C. Chinthammit ◽  
S. Bhattacharjee ◽  
M. Slack ◽  
W. Lo-Ciganic ◽  
J.P. Bentley ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Medication Use ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Dual Eligibility

scholarly journals Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽  
2021 ◽  
Author(s):  
G L Dunietz ◽  
R D Chervin ◽  
J F Burke ◽  
A S Conceicao ◽  
T J Braley
Keyword(s):  
Older Adults ◽  
Statistical Significance ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Not Otherwise Specified ◽  
Dementia Risk ◽  
Obstructive Sleep ◽  
Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

scholarly journals Relations between cognitive status and medication adherence in patients treated for memory disorders

2012 ◽  
Vol 3 (1) ◽  
pp. 2 ◽  
Author(s):  
Raymond L. Ownby ◽  
Christopher Hertzog ◽  
Sara J. Czaja
Keyword(s):  
Medication Adherence ◽  
Electronic Monitoring ◽  
Cognitive Status ◽  
Path Model ◽  
Elderly Persons ◽  
Poor Health Status ◽  
Memory Problems ◽  
Treatment Conditions ◽  
Electronic Monitoring Device ◽  
Over Time

Medication adherence has been increasingly recognized as an important factor in elderly persons’ health. Various studies have shown that medication non-adherence is associated with poor health status in this population. As part of a study of the effects of two interventions to promote medication adherence in patients treated for memory problems, information on medication adherence and cognitive status was collected at 3-month intervals. Twenty-seven participants (16 men, 11 women, age 71-92 years) were assigned to control or treatment conditions and adherence was evaluated with an electronic monitoring device. Cognitive status was evaluated at 3- month intervals beginning in April of 2003 and continuing through September of 2006. We have previously reported on the effectiveness of these interventions to promote adherence. In this paper, we examine the relations of cognitive status and adherence over time using a partial least squares path model in order to evaluate the extent to which adherence to cholinesterase medications was related to cognitive status. Adherence predicted cognitive status at later time points while cognition did not, in general, predict adherence. Results thus suggest that interventions to ensure high levels of medication adherence may be important for maintaining cognitive function in affected elderly people.

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

2021 ◽  
Vol 10 (1) ◽  
pp. 304-308
Author(s):  
Kenneth A. Blocker ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Illness Representation ◽  
Effective Management ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Hypertension Knowledge ◽  
Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

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