Abstract

OBJECTIVES:

To examine the relationship that the patient has with his/her healthcare practitioner as a factor affecting medication adherence.

STUDY DESIGN:

Aggregate, physician-level adherence rates for patients were compared in a retrospective, non-case-controlled study of 3777 diabetes patients enrolled in a commercial pharmacy benefits program in a 6-county area in northeast Ohio.

METHODS:

Data for the top prescribing 200 physicians and their 3777 patients were analyzed based on the adherence of their patients to medications for diabetes, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). Physicians were then separated into adherence quartiles based on the results. Statistical tests for assessing between-group differences were performed. Results were reported for diabetes medication-specific adherence as well as adherence to statins and ACEIs/ARBs.

RESULTS:

No appreciable demographic differences were noted between patient or physician groups, including age, sex, race, cost share, and chronic medication use. Statistically significant differences in aggregate physician-specific medication adherence between the best performing and worst performing physician quartiles were identified, with medication adherence rates of 89.5% for the highest performing quartile compared with 68.1% for the lowest performing quartile. Medication adherence for statins and ACEIs/ARBs paralleled the results for diabetes medications: 88.4% versus 73.4% and 89.8% versus 76.9%, respectively. Importantly, significantly fewer patients in the lowest performing physician group had filled prescriptions for statins or ACEIs/ARBs.

CONCLUSIONS:

Physician-specific factors have an underappreciated impact on medication adherence. A better understanding of these factors may have substantial benefit in improving compliance with treatment and clinical outcomes.