Abstract 47: Adherence to Antihypertensive Medications is Associated with Fewer Cardiovascular Related Hospitalizations and ED Visits in Patients 65 and Older

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Donald G Pittman ◽  
Zhuliang Tao ◽  
Edward S Eisenberg ◽  
Merri Pendergrass
Keyword(s):  
Medicare Part D ◽  
Emergency Department Visits ◽  
Antihypertensive Medications ◽  
Part D ◽  
Medical Claims ◽  
Pharmacy Claims ◽  
Proportion Of Days Covered ◽  
Ed Visits ◽  
Artery Disease ◽  
The Relationship

Objective To examine the relationship between Antihypertensive Medication (AHM) adherence and subsequent cardiovascular related hospitalizations (CVH) and emergency department visits (CVED) in patients 65+ years of age. Methods A retrospective cohort study of patients 65+ years of age receiving AHM therapy was performed. Patients had deidentified data on medical and pharmacy claims in the Medco Health Solutions, Inc. integrated warehouse, and were continuously enrolled in coverage from January 2009 through June 2011. Medication adherence was assessed by proportion of days covered (PDC) over 1 year, and risk of CVH and CVED over the subsequent year. Patients were segmented into three adherence cohorts based on PDC: 80 to 100% (adherent), 60 to 79% and <60%. Risk of CVH and CVED visits was determined by medical claims during the subsequent 12 months. Results Among the 316,108 total eligible adults, mean age was 74.9 +/-6.1 years; 57.5% were women, 82.4% were hypertensive, 28.3% had coronary artery disease (CAD), 14.1% had stroke, 9.6% had heart failure (HF) and 32.5% had diabetes. A subset that included only Medicare Part D (Med-D) plan participants (n=26,248, mean age 74.3 +/-5.8 years) had a greater percentage of women and comorbidities vs. the non-Med-D patients (n=298,860, mean age 75.0 +/-6.1 years). Comorbidity differences between the Med-D vs. non-Med-D groups were: Women 64.5% vs. 56.8%; hypertension 93.6% vs. 81.4%; CAD 34.8% vs.27.7%; stroke 16.0% vs. 13.9.%; HF 15.4% vs. 9.0%; and diabetes 54.9% vs. 30.5%, p<0.0001 for all groups. Overall, mean PDC was 91% (+/-15%) and was lower in the Med-D group at 89% (+/-17%) vs. non-Med-D group at 91% (+/-14%). The majority, 271,002 (85.7%) had PDC ≥80%; 26,973 (8.5%) had PDC of 60-79% and 18,133 (5.7%) had PDC of <60%. After adjustment for age, sex, comorbidities, year 1 hospitalizations and ED visits, and total medications, the overall risk of CVH was significantly greater with PDC 60-79% (OR 1.23; CI 1.19-1.28) and PDC <60% (OR 1.31; CI 1.25-1.37), p<0.0001 vs. PDC ≥80%. The risk of CVED was increased with PDC 60-79% (OR 1.18; CI 1.12-1.24) and PDC <60% (OR 1.29; CI 1.22-1.37), p<0.0001 vs. PDC ≥80%. Patients covered by Med-D plans with PDC < 60% had the greatest risk of CVH (OR 1.42; CI 1.26-1.59) and CVED (OR 1.49 CI 1.32-1.68). Conclusions For patients 65+ years of age, one in seven was nonadherent to AHM medications. Adherence to AHM was associated with an inverse risk of CVH and CVED. The risk of increased CVH and CVED was even more pronounced in Med-D plan participants with the poorest nonadherence.

Abstract 326: Adherence to Statins is Associated with Fewer Cardiovascular Related Hospitalizations and ED Visits in Patients 65 and Older

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Donald G Pittman ◽  
Zhuliang Tao ◽  
Edward S Eisenberg ◽  
Merri Pendergrass
Keyword(s):  
Medicare Part D ◽  
Emergency Department Visits ◽  
Part D ◽  
Medical Claims ◽  
Adjusted Risk ◽  
Pharmacy Claims ◽  
Proportion Of Days Covered ◽  
Ed Visits ◽  
Artery Disease ◽  
The Relationship

Objective To examine the relationship between adherence to statins and subsequent cardiovascular related hospitalizations (CVH) and emergency department visits (CVED) in patients 65+ years of age. Methods A retrospective cohort study of patients 65+ years of age receiving statin therapy was performed. Patients had deidentified data on medical and pharmacy claims in the Medco Health Solutions, Inc. integrated warehouse, and were continuously enrolled in coverage from January 2009 through June 2011. Medication adherence was assessed by proportion of days covered (PDC) over 1 year, and risk of CVH and CVED over the subsequent year. Patients were segmented into three adherence cohorts based on PDC: 80 to 100% (adherent), PDC 60 to 79% and PDC <60%. Risk of CVH and CVED was determined by medical claims during the subsequent 12 months. Results Among the 225,802 total eligible adults, mean age was 74.4 +/-6.0 years; 53.7% were women, 73.1% (165,060) had hypertension, 31.5% (71,069) had coronary artery disease (CAD), 14.5% (32,713) had stroke, 8.3% (18,801) had heart failure (HF) and 33.3% (75,205) had diabetes. A subset that included only Medicare Part D (Med-D) plan participants (n=17,462, mean age 73.8 +/-5.6 years) had a greater percentage of women and comorbidities vs. the non-Med-D patients (n=208,340, mean age 74.4 +/-6.0 years). Comorbidity differences between the Med-D vs. non-Med-D groups were: Women 62.7% vs. 52.3%; hypertension 89.2% vs. 71.8%; CAD 38.1% vs.30.9%; stroke 16.8% vs. 14.3%; HF 14.2% vs. 7.8%; and diabetes 56.2% vs. 31.4%, p<0.0001 for all groups. Overall, mean PDC was 84% (+/-17%) and was lower in the Med-D group at 80% (+/-21%) vs. non-Med-D group at 85% (+/-17%). The majority, 167,356 (74.1%), were adherent with PDC ≥80%; 33,453 (14.8%) had PDC of 60-79% and 24,993 (11.1%) had PDC of <60%. After adjustment for age, sex, comorbidities, year 1 hospitalizations and ED visits, and total medications, the overall risk of CVH was significantly greater with PDC 60-79% (OR 1.14; CI 1.10-1.18) and PDC <60% (OR 1.28; CI 1.23-1.33), p<0.0001 compared to PDC ≥80%. The risk of CVED was increased with PDC 60-79% (1.15; CI 1.10-1.21) and PDC <60% (OR 1.43; CI 1.35-1.51), p<0.0001 compared to PDC ≥80%. The fully adjusted risk of CVH and CVED were similar between Med-D and non-Med-D plan patients. Conclusions For patients 65+ years of age, one in four was nonadherent to statin medications. Adherence to statins was associated with an inverse risk of CVH and CVED.The risk of increased CVH and CVED was similar in Med-D plan and non-Med-D participants with nonadherence.

scholarly journals Variation in emergency department visits for conditions that may be treated in alternative primary care settings

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 252-256 ◽  
Author(s):  
Chris A. Altmayer ◽  
Sten Ardal ◽  
Graham L. Woodward ◽  
Michael J. Schull
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Geographic Variation ◽  
Emergency Department Visits ◽  
Primary Care Settings ◽  
Rural Counties ◽  
Ed Visits ◽  
Care Capacity ◽  
The Relationship

ABSTRACT The purpose of this report is to examine Ontario's geographic variation in emergency department (ED) visits for conditions that may be treated in alternative primary care settings. We studied all visits to Ontario EDs in 2002/03 and calculated county-specific age-standardized rates. Overall in Ontario, there were 3174 ED visits per 100 000 population aged 1-74 for conditions that could be treated in alternate primary care settings, but rates varied widely across counties. They were higher in rural counties with rates up to 7-fold higher than the provincial average. Urban counties had lower rates, some were less than one-third of the provincial average. Further research is needed to determine the relationship between ED utilization and primary care capacity.

scholarly journals Part D Formulary and Benefit Design as a Risk-Steering Mechanism

2011 ◽  
Vol 101 (3) ◽  
pp. 382-386 ◽  
Author(s):  
Dana P Goldman ◽  
Geoffrey F Joyce ◽  
William B Vogt
Keyword(s):  
Simulation Model ◽  
Adverse Selection ◽  
Drug Users ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Benefit Design ◽  
Pharmacy Claims ◽  
Prescription Drug Plans ◽  
Steering Mechanism

Medicare Part D relies upon drug plan competition. Plans have enormous scope to design benefits and to set premiums, but they may not charge differential premiums based on risk. We use the formulary and benefit design of all Medicare prescription drug plans and pharmacy claims data to construct a simulation model of out-of-pocket drug spending. We use this simulation model to examine individual incentives in Medicare Part D for adverse selection. We find that high drug users have much stronger incentives to enroll in generous plans than do low users, thus there is significant scope for adverse selection.

Geosocial Factors Associated With Adherence to Statin Medications

2020 ◽  
Vol 54 (12) ◽  
pp. 1194-1202 ◽  
Author(s):  
Steven R. Erickson ◽  
Mercedes Bravo ◽  
Joshua Tootoo
Keyword(s):  
Age Groups ◽  
Patient Characteristics ◽  
Racial Isolation ◽  
Geographic Accessibility ◽  
Public Health Initiative ◽  
Pharmacy Claims ◽  
The Social ◽  
Proportion Of Days Covered ◽  
Statin Adherence ◽  
The Relationship

Background: Individual patient characteristics, social determinants, and geographic access may be associated with patients engaging in appropriate health behaviors. Objective: To assess the relationship between statin adherence, geographic accessibility to pharmacies, and neighborhood sociodemographic characteristics in Michigan. Methods: The proportion of days covered (PDC) was calculated from pharmacy claims of a large insurer of adults who had prescriptions for statins between July 2009 and June 2010. A PDC ≥0.80 was defined as adherent. The predictor of interest was a ZIP code tabulation area (ZCTA)-level measure of geographic accessibility to pharmacies, measured using a method that integrates availability and access into a single index. We fit unadjusted models as well as adjusted models controlling for age, sex, and ZCTA-level measures of socioeconomic status (SES), racial isolation (RI) of non-Hispanic blacks, and urbanicity. Results: More than 174 000 patients’ claims data were analyzed. In adjusted models, pharmacy access was not associated with adherence (0.99; 95% CI: 0.96, 1.03). Greater RI (0.87; 95% CI: 0.85, 0.88) and urban status (0.93; 95% CI: 0.89, 0.96) were associated with lower odds of adherence. Individuals in ZCTAs with higher SES had higher odds of adherence, as were men and older age groups. Conclusion and Relevance: Adherence to statin prescriptions was lower for patients living in areas characterized as being racially segregated or lower income. Initiating interventions to enhance adherence, informed by understanding the social and systematic barriers patients face when refilling medication, is an important public health initiative that pharmacists practicing in these areas may undertake.

scholarly journals Association between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 976
Author(s):  
Angshuman Gooptu ◽  
Michael Taitel ◽  
Neda Laiteerapong ◽  
Valerie G. Press
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Adverse Drug Events ◽  
Treatment Plan ◽  
Medicare Part D ◽  
Medicare Part ◽  
Medication Regimen ◽  
Part D ◽  
Pharmacy Claims

Importance: Medication non-adherence is highly costly and leads to worse disease control and outcomes. However, knowledge about medication adherence is often disconnected from prescribing decisions, and this disconnect may lead to inappropriate increases in medications and higher risks of adverse events. Objectives: To evaluate the association between medication non-adherence and the likelihood of increases in the intensity of medication regimens for two chronic conditions, hypertension and type 2 diabetes. Design: Cohort Study. Setting and Participants: This study used US national pharmacy claims data for Medicare Part D (ages ≥ 65) and commercial (ages 50–64) plans to evaluate medication adherence and its association with the likelihood of receiving an increase in medication intensity for patients with hypertension and/or oral diabetes medication fills. Patients had an index fill for hypertension (N = 2,536,638) and/or oral diabetes (N = 701,376) medications in January 2015. Medication fills in the follow-up period from August 2015 to December 2016 were assessed for increases in medication regimen intensity. Main Outcome(s) and Measure(s): The proportion of days covered (PDC) over 181 days was used as a measure for patient’s medication adherence before a medication addition, medication increase, or dosage increase. Differences in the likelihood of experiencing an escalation in medication intensity was considered between patients with a PDC < 80% vs. PDC ≥ 80%. Results: Among Medicare Part D and commercial plan patients filling hypertension and/or oral diabetes medications, non-adherent patients were significantly more likely to experience an intensification of their medication regimens (p < 0.001). Conclusions and Relevance: This study found a significant association between non-adherence to medications and a higher likelihood of patients experiencing potentially inappropriate increases in treatment intensity. Sharing of objective patient refill data between retail pharmacies and prescribers can enable prescribers to have more targeted discussions with patients about their adherence and overall treatment plan. Additionally, it can increase safe medication prescribing and plausibly reduce adverse drug events and healthcare costs while improving patient health outcomes.

scholarly journals Emergency department visits due to coronary artery disease during COVID-19 in Finland: A register-based study

2021 ◽  
pp. 140349482110384
Author(s):  
Mikko Uimonen ◽  
Ville Ponkilainen ◽  
Ilari Kuitunen ◽  
Markku Eskola ◽  
Ville M. Mattila
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Coronary Artery ◽  
Health Care Services ◽  
Emergency Department Visits ◽  
Annual Incidence ◽  
Multi Centre Study ◽  
Coronary Syndrome ◽  
Ed Visits ◽  
Artery Disease

Aims: This multi-centre study examined the effects of restricted availability of health-care services during the COVID-19 pandemic on treatment of coronary artery disease (CAD) in Finland. Methods: Data on referrals to cardiological units ( n=81,008), emergency department (ED) visits ( n=10,001) and hospitalisations ( n=8654) for CAD were collected from three large Finnish hospitals, and incidences were calculated per 100,000 persons for the years 2017 through 2020. Year 2020 was compared to the reference years 2017–2019 by incidence rate ratios (IRR) with 95% confidence intervals (CI). Results: Referrals to cardiological units decreased after the onset of the pandemic in March to May (IRR=0.83, 95% CI 0.81–0.86). ED visits due to acute coronary syndrome decreased during the first months of the pandemic, with the overall annual incidence 2–14% lower than in the reference years. ED visits due to chronic CAD increased prominently during in April and May compared to the corresponding months in the reference years (IRR=1.49, 95% CI 1.23–1.81 in April; IRR=1.57, 95% CI 1.32–1.89 in May) and remained elevated until the end of 2020, with an increase in annual incidence of 17% (IRR=1.17, 95% CI 1.11–1.24). Conclusions: The first COVID-19 wave decreased ED visits due to acute coronary syndromes and increased those due to chronic CAD. The changes in referral and ED visit incidences during the second wave were rather modest.

Impact of medication synchronization programs on proportion of days covered (PDC) scores and Medicare Part D medication-related adherence metrics

2019 ◽  
Vol 59 (3) ◽  
pp. 343-348 ◽  
Author(s):  
Kaitlyn Bernard ◽  
Brooke Cowles ◽  
Kenneth McCall ◽  
Rose Mary Henningsen ◽  
Moira O’Toole ◽  
...  
Keyword(s):  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Proportion Of Days Covered

scholarly journals National Rates of Nonadherence to Antihypertensive Medications Among Insured Adults With Hypertension, 2015

Hypertension ◽  
2019 ◽  
Vol 74 (6) ◽  
pp. 1324-1332 ◽  
Author(s):  
Tiffany E. Chang ◽  
Matthew D. Ritchey ◽  
Soyoun Park ◽  
Anping Chang ◽  
Erika C. Odom ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Insurance ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Medicare Part D ◽  
Pressure Control ◽  
Insurance Plan ◽  
Health Insurance Plan ◽  
Antihypertensive Medications ◽  
Part D

Despite the importance of antihypertensive medication therapy for blood pressure control, no single data system provides estimates of medication nonadherence rates across age groups and health insurance plans types. Using multiple administrative datasets and national survey data, we determined health insurance plan-specific and overall weighted national rates of nonadherence to antihypertensive medications among insured hypertensive US adults in 2015. We used 2015 prescription claims data from Medicare Part D and 3 IBM MarketScan databases (Commercial, Medicaid, Medicare Supplemental) to calculate medication nonadherence rates among hypertensive adults aged ≥18 years with public or private health insurance using the proportion of days covered algorithm. These findings, in combination with National Health Interview Survey findings, were used to project national weighted estimates of nonadherence. We included 23.8 million hypertensive adults who filled 265.8 million prescriptions for antihypertensive medications. Nonadherence differed by health insurance plan type (highest for Medicaid members, 55.4%; lowest for Medicare Part D members, 25.2%). The overall weighted national nonadherence rate was 31.0%, with greater nonadherence among women versus men, younger versus older adults (aged 18–34 years, 58.1%; aged 65–74 years, 24.4%), fixed-dose combination medication nonusers (31.2%) versus users (29.4%), and by pharmacy outlet type (retail only, 30.7%; any mail order, 19.8%). In 2015, almost one-third (≈16.3 million) of insured US adults with diagnosed hypertension were considered nonadherent to their antihypertensive medication regimen, and considerable disparities were evident. Public health and healthcare professionals can use available evidence-based interventions to address nonadherence and improve blood pressure control.

Patient Perception of Physicians and Medication Adherence Among Older Adults With Hypertension

2018 ◽  
Vol 32 (1-2) ◽  
pp. 95-105
Author(s):  
Lori M. Ward ◽  
Joseph Thomas
Keyword(s):  
Antihypertensive Medication ◽  
Medicare Part D ◽  
Patient Perception ◽  
Medicare Beneficiaries ◽  
Physician Patient Relationship ◽  
Antihypertensive Medications ◽  
Medicare Current Beneficiary Survey ◽  
Part D ◽  
The Mean ◽  
Physician Patient

Objective: To assess association between patient perception of physicians and adherence to antihypertensive medication among Medicare beneficiaries. Method: Logistic regression was used to assess association between the Patient Perception of Physicians Scale score and adherence to antihypertensive medication. The 2007 Medicare Current Beneficiary Survey data were used to create a 12-item patient perception of physician scale and 2008 Medicare Part D claims to assess adherence. Results: There were 2,510 beneficiaries included in the sample. The mean age was 76.4 years ( SD = ±6.88 years). Sixty-five percent of the sample was adherent in filling their antihypertensive medication. Beneficiaries with more favorable perceptions of their physician (scores 37 or higher) were more likely to be adherent to antihypertensive medications than beneficiaries with scores less than 37 (odds ratio [OR] = 1.341, 95% confidence interval [CI] = [1.101, 1.632], p = .0035). Discussion: These findings provide some evidence that patient perceptions of their physician are associated with adherence, and that the physician–patient relationship is an important factor.

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