Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

Background: The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear. Objective: To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization. Methods: This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented. Results: Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate. Conclusion and Relevance: Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

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Medication Adherence, Health Care Utilization, and Spending Among Privately Insured Adults With Chronic Conditions in the United States, 2010-2016

The American Journal of Medicine ◽

10.1016/j.amjmed.2019.12.021 ◽

2020 ◽

Vol 133 (6) ◽

pp. 690-704.e19 ◽

Cited By ~ 2

Author(s):

Catherine W. Gillespie ◽

Pamela E. Morin ◽

Jamie M. Tucker ◽

Leigh Purvis

Keyword(s):

United States ◽

Health Care ◽

Medication Adherence ◽

Health Care Utilization ◽

Chronic Conditions ◽

The United States ◽

Care Utilization ◽

Privately Insured

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Self-Regulation Strategies as Predictors: Managing Multimorbidities Among Community-Dwelling People Aging with Arthritis

Western Journal of Nursing Research ◽

10.1177/0193945919893679 ◽

2020 ◽

Vol 42 (9) ◽

pp. 698-707 ◽

Cited By ~ 1

Author(s):

Wenhui Zhang ◽

Kavita Radhakrishnan ◽

Heather Becker ◽

Gayle J. Acton ◽

Carole K. Holahan

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Self Efficacy ◽

Self Regulation ◽

Health Resources ◽

Physical Symptoms ◽

Community Dwelling ◽

Care Utilization ◽

Multiple Chronic Conditions ◽

Regulation Strategies

Self-regulation (SR) has been defined as consisting of three basic strategies: selection, optimization, and compensation. This study investigates these three SR strategies as predictors of arthritis self-efficacy, quality of life (QOL), and health-care utilization in community-dwelling people aging with arthritis and comorbidities. One hundred forty individuals over age 50 years provided demographic characteristics and completed surveys on comorbidities, health resources, use of SR strategies, symptoms, arthritis self-efficacy, QOL, and health-care utilization. Multivariate hierarchical stepwise regressions were used to examine SR strategies as predictors for arthritis self-efficacy, and together with arthritis self-efficacy as predictors for health-care utilization, and QOL. Physical symptoms; SR strategies, especially optimization; and income adequacy significantly predicted arthritis self-efficacy. Arthritis self-efficacy and mental and physical symptoms significantly predicted QOL. This study adds evidence to support the role of SR strategies, especially optimization, in building arthritis self-efficacy for better self-management and QOL in persons with arthritis and multiple chronic conditions.

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