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.

Association Between Prescription Drug Insurance and Health Care Utilization Among Medicare Beneficiaries

2016 ◽  
Vol 75 (2) ◽  
pp. 153-174
Author(s):  
G. Caleb Alexander ◽  
Cuiping Schiman ◽  
Robert Kaestner
Keyword(s):  
Length Of Stay ◽  
Medicare Part D ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Medicare Current Beneficiary Survey ◽  
Part D ◽  
Drug Insurance ◽  
Clinically Significant ◽  
Instrumental Variables Approach ◽  
Mean Charge

Medicare Part D was associated with reduced hospitalizations, yet little is known whether these effects varied across patients and how Part D was associated with length of stay and inpatient expenditures. We used Medicare claims and the Medicare Current Beneficiary Survey from 2002 to 2010 and an instrumental variables approach. Gaining drug insurance through Part D was associated with a statistically significant 8.0% reduction in likelihood of admission across conditions examined. Reductions were generally greater for younger, healthier, and male individuals. Across all conditions, mean length of stay decreased by 3.2% from a baseline of 5.1 days. Part D was associated with a 3.5% reduction in expenditures per admission, reflecting a decrease of $844 from a mean charge of $24,124 per admission prior to Part D. Thus, Part D was associated with statistically and clinically significant reductions in the probability of admission and length of stay for several common conditions.

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.

Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lisa M Lewis
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Qualitative Study ◽  
Antihypertensive Medication ◽  
Demographic Data ◽  
Patient Treatment ◽  
List Type ◽  
Medication Regimen ◽  
Antihypertensive Medications ◽  
The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

scholarly journals Effect of Dual Use of Veterans Affairs and Medicare Part D Drug Benefits on Antihypertensive Medication Supply in a National Cohort of Veterans with Dementia

2018 ◽  
Vol 53 ◽  
pp. 5375-5401 ◽  
Author(s):  
Carolyn T. Thorpe ◽  
Walid F. Gellad ◽  
Maria K. Mor ◽  
John P. Cashy ◽  
John R. Pleis ◽  
...  
Keyword(s):  
Antihypertensive Medication ◽  
Medicare Part D ◽  
Veterans Affairs ◽  
Medicare Part ◽  
Dual Use ◽  
Part D ◽  
Drug Benefits ◽  
National Cohort

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.

Medicare Part D is Associated With Reducing the Financial Burden of Health Care Services in Medicare Beneficiaries With Diagnosed Diabetes

Medical Care ◽  
2013 ◽  
Vol 51 (10) ◽  
pp. 888-893 ◽  
Author(s):  
Rui Li ◽  
Edward W. Gregg ◽  
Lawrence E. Barker ◽  
Ping Zhang ◽  
Fang Zhang ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Financial Burden ◽  
Medicare Part D ◽  
Medicare Part ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Care Services ◽  
Diagnosed Diabetes

scholarly journals ME4 THE IMPACT OF MEDICARE PART D ON HEALTH CARE UTILIZATION AND HEALTH OF THE MEDICARE BENEFICIARIES

2010 ◽  
Vol 13 (3) ◽  
pp. A7
Author(s):  
FX Liu ◽  
GC Alexander ◽  
SY Crawford ◽  
AS Pickard ◽  
DR Hedeker ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Medicare Part D ◽  
Medicare Part ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Part D ◽  
The Impact

scholarly journals Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes

2015 ◽  
Vol 22 (5) ◽  
pp. 1094-1098 ◽  
Author(s):  
Christopher Powers ◽  
Meghan Hufstader Gabriel ◽  
William Encinosa ◽  
Farzad Mostashari ◽  
Julie Bynum
Keyword(s):  
Adverse Drug Events ◽  
Meaningful Use ◽  
Medicare Part D ◽  
Medicare Part ◽  
Ambulatory Setting ◽  
Diabetic Patients ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Use Stage ◽  
Reduced Risk

Abstract Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the “prescription origin code” in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider’s panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations.

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