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Med Care. 2013 Oct;51(10):879-87. doi: 10.1097/MLR.0b013e31829fa8ed.

Multiple medication adherence and its effect on clinical outcomes among patients with comorbid type 2 diabetes and hypertension.

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  • 1*Pharmacy Analytical Services Research Group, Kaiser Permanente Southern California, Downey †Schaeffer Center for Health Policy and Economics, University of Southern, California, Los Angeles, CA.

Abstract

OBJECTIVE:

To investigate multiple medication adherence (MMA) and its impact on microvascular and macrovascular complications using instrumental variables (IVs).

RESEARCH DESIGN:

A retrospective observational study was conducted using administrative claims and electronic medical records from a large physician group in Southern California (N=2334).

SUBJECTS:

We identified individuals between January 2006 and June 2009 newly starting oral diabetes (DM) or hypertension (HTN) medications with preexisting comorbid HTN or DM prescription history.

MEASURES:

MMA was defined as a proportion of days covered where both DM and HTN medications were simultaneously available over a 33-month follow-up period. Microvascular or macrovascular complications included myocardial infarction, stroke, renal failure, and diabetic retinopathy. Multivariable logistic regressions and an IV estimation using physician-related variables were implemented.

RESULTS:

MMA was supoptimal as the mean (SD) proportion of days covered was 0.53 (0.32). Patients were more adherent to medications for a preexisting condition in comparison with those for the newer disease. Older age, number of index medications [OR (95% CI)=1.36 (1.22-1.52)], receiving care from a physician who prescribed statin more frequently [OR (95% CI)=2.63 (1.67-4.14)], and receiving care from the same physician for both DM and HTN [OR (95% CI)=1.57 (1.08-2.27)] were significant factors of being adherent. Using physician-related IVs, MMA reduced microvascular and macrovascular complications. The increase in MMA from 50% to 80% reduced the average predicted probability of microvascular or macrovascular complication rate by 29.5%.

CONCLUSIONS:

Adherence to medications for DM and HTN were differed and higher MMA reduced microvascular or macrovascular complications when controlling for endogeneity bias.

PMID:
23929398
[PubMed - indexed for MEDLINE]
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