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J Pharm Health Serv Res. 2017 Dec;8(4):247-253. doi: 10.1111/jphs.12193. Epub 2017 Aug 7.

Examining Factors Associated With Nonadherence And Identifying Providers Caring For Nonadherent Subgroups.

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Daniel K. Inouye College of Pharmacy, University of Hawaii, 677 Ala Moana Blvd, Suite 1025, Honolulu, Hawaii 96813.
AC# 0857, Keefe Campus Center, Amherst College, Amherst, MA 01002-5000.
Office of Biostatistics & Quantitative Health Sciences, John. A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813.
Department of Medicine, John. A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813.
Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213.



To examine racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities.


Administrative claims data was analyzed for members enrolled in a large health plan in Hawaii (2008-2010) with diabetes mellitus who were taking three types of medications: 1) oral anti-diabetic medications; 2) anti-hypertensive medications; 3) cholesterol lowering medications (n=5136). The primary outcome was medication adherence based on medication possession ratios. Multivariable logistic regression models were estimated to examine the association between race/ethnicity and region to adherence to each drug class separately, followed by non-adherence to all three. Covariates included age, gender, education level, chronic conditions, copayment level, and number of prescribers and pharmacies from which the patients received their medications.

Key Findings:

After adjustment for other factors, Filipinos [OR=0.58, 95%CI(0.45,0.74)], Native Hawaiians [OR=0.74, 95%CI(0.56,0.98)], and people of other race [OR=0.67, 95%CI(0.55,0.82)] were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese. For cholesterol-lowering medications, all racial and ethnic groups were significantly less adherent than Japanese, except mixed race. We also found that different racial/ethnic groups tended to use different pharmacies and prescribers, particularly in rural areas.


Adherence differed by race/ethnicity as well as age and region. Qualitative research involving subgroups (e.g. Filipinos, Native Hawaiians, people under age 50) is needed to identify how to adapt and enhance the effects of interventions shown to be efficacious in prior studies.


Health Services Research; Outcomes Research; Pharmaceutical HSR

Conflict of interest statement

Conflict of Interest: None of the authors have conflicts of interest or financial interests of the nor do members of their immediate families, regarding any product or service discussed in the manuscript, including grants - pending or received -, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents, and royalties.

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