Impact of concurrent medication use on statin adherence and refill persistence.

BACKGROUND Effective therapy for chronic illness requires daily medication adherence (DMA) for prolonged periods. Overall medical regimen complexity may represent one barrier to successful adherence. METHODS To assess the relationship between the number of concurrently prescribed medicines and adherence to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), we analyzed a cohort of 5488 patients in a single health insurance plan who began statin therapy between July 1, 1999, and June 30, 2002. We assessed 2 parameters of statin adherence: (1) DMA ([total number of pills dispensed/total number of days between first and last prescription] x100) and (2) refill persistence (RP) (consecutive months of refills after initial prescription). RESULTS The cohort was 61.6% male, with a mean +/- SD age of 52.7 +/- 9.3 years. Patients were prescribed a mean +/- SD of 2.9 +/- 2 total medicines (range, 1-13), with a mean +/- SD statin DMA of 82.1% +/- 26.5%. By 12 months, only 68% of patients continued filling statin prescriptions. After controlling for age, income level, and treatment for hypertension or ischemic heart disease, a greater number of concurrently prescribed medicines was significantly associated with better DMA (P = .005) and longer RP (P = .03). CONCLUSIONS In this cohort, statin DMA was generally adequate, but RP was suboptimal. Patients with more concurrently prescribed medicines had higher DMA and better RP, even after adjusting for demographic factors and cardiovascular comorbidity. Physicians should not be deterred from initiating statin therapy by a patient's medical regimen complexity but should be alert for lack of therapy persistence, particularly in younger and healthier patients.

[1]  J. Ornato,et al.  ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article , 2005 .

[2]  D. Singer,et al.  Trends in complexity of diabetes care in the United States from 1991 to 2000. , 2004, Archives of internal medicine.

[3]  J. Slattery,et al.  Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 1994. , 1994, Atherosclerosis. Supplements.

[4]  E. Keeler,et al.  Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients. , 2003, JAMA.

[5]  D. Singer,et al.  Polypharmacy and medication adherence in patients with type 2 diabetes. , 2003, Diabetes care.

[6]  Douglas W Mahoney,et al.  Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. , 2003, JAMA.

[7]  John D. Voss,et al.  Predictors of Medication-Refill Adherence in an Indigent Rural Population , 2002, Medical care.

[8]  Muhammad Mamdani,et al.  Adherence with statin therapy in elderly patients with and without acute coronary syndromes. , 2002, JAMA.

[9]  M. Weinstein,et al.  Long-term persistence in use of statin therapy in elderly patients. , 2002, JAMA.

[10]  K. Hassell,et al.  Access to medicines: cost as an influence on the views and behaviour of patients. , 2002, Health & social care in the community.

[11]  R. Heller,et al.  Hypertension control and medication increase in primary care , 2002, Journal of Human Hypertension.

[12]  P. Donnan,et al.  Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[13]  E. Antman,et al.  ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary , 2002 .

[14]  R. Nuesch,et al.  Relation between insufficient response to antihypertensive treatment and poor compliance with treatment: a prospective case-control study , 2001, British medical journal.

[15]  D. Malone,et al.  The Relationship between Drug Therapy Noncompliance and Patient Characteristics, Health‐Related Quality of Life, and Health Care Costs , 2000, Pharmacotherapy.

[16]  HOMAS,et al.  The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels , 2000 .

[17]  Ames,et al.  PREVENTION OF CORONARY HEART DISEASE WITH PRAVASTATIN IN MEN WITH HYPERCHOLESTEROLEMIA , 2000 .

[18]  A. Gotto.  Lipid management in patients at moderate risk for coronary heart disease: insights from the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). , 1999, The American journal of medicine.

[19]  S. Soumerai,et al.  Inadequate Prescription-Drug Coverage for Medicare Enrollees — A Call to Action , 2017 .

[20]  J. Avorn,et al.  Persistence of use of lipid-lowering medications: a cross-national study. , 1998, JAMA.

[21]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[22]  J. LoGerfo,et al.  Assessing compliance to antihypertensive medications using computer-based pharmacy records. , 1997, Medical care.

[23]  A V Prochazka,et al.  The assessment of refill compliance using pharmacy records: methods, validity, and applications. , 1997, Journal of clinical epidemiology.

[24]  B. Davis,et al.  The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. , 1996, The New England journal of medicine.

[25]  B. Martin,et al.  The impact of implementing a more restrictive prescription limit on Medicaid recipients. Effects on cost, therapy, and out-of-pocket expenditures. , 1996, Medical care.

[26]  R. Platt,et al.  Discontinuation of antihyperlipidemic drugs--do rates reported in clinical trials reflect rates in primary care settings? , 1995, The New England journal of medicine.

[27]  P Whelton,et al.  Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. , 1995, Hypertension.

[28]  Scandinavian Simvastatin Survival Study Group.  Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) , 1994, The Lancet.

[29]  P. Moorman,et al.  Socioeconomic status and morbidity and mortality in hypertensive blacks. , 1991, Cardiovascular clinics.

[30]  T D Koepsell,et al.  A General Method of Compliance Assessment Using Centralized Pharmacy Records: Description and Validation , 1988, Medical care.

[31]  I. Rosenstock,et al.  Social Learning Theory and the Health Belief Model , 1988, Health education quarterly.

[32]  Stephen B. Soumerai,et al.  Payment Restrictions for Prescription Drugs under Medicaid , 1987 .

[33]  S B Soumerai,et al.  Payment restrictions for prescription drugs under Medicaid. Effects on therapy, cost, and equity. , 1987, The New England journal of medicine.

[34]  N. Shulman,et al.  Financial cost as an obstacle to hypertension therapy. , 1986, American journal of public health.

[35]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[36]  D.,et al.  Regression Models and Life-Tables , 2022 .