Multiple Medication Adherence and its Effect on Clinical Outcomes Among Patients With Comorbid Type 2 Diabetes and Hypertension

Bibliographic Data

ID9103249
AuthorsJaeJin An (0000-0002-3161-5732, Analytical Services, corresponding author), Michael B Nichol (0000-0003-4989-9806, University of Southern California)
Year2013
Volume51
Issue10
Pages879-887
Publication date2013-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31829fa8ed
PMID23929398
OpenAlexW2084822528
LanguageEN
Citations received2
References cited16

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

Diabetes mellitus · Logistic regression · Macrovascular disease · Medical prescription · Medical record · Myocardial infarction · Retrospective cohort study · Statin · Stroke (engine) · Type 2 diabetes · Chronic Disease Management Strategies · Emergency Medicine · Internal Medicine · Medication Adherence and Compliance · Medicine · Pharmaceutical Practices and Patient Outcomes

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