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Relationships between Medication Adherence and Cardiovascular Disease Risk Factor Control in Elderly Patients with Diabetes.

ABSTRACT: BACKGROUND:The Centers for Medicare and Medicaid Services (CMS) Medicare Star program provides incentives to health plans when their patients with diabetes meet adherence targets to angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) and statins. While a link between adherence and cardiovascular risk factor control is established, most studies included young patients with few comorbidities. Whether the Star adherence target is associated with reduced blood pressure or low-density lipoprotein cholesterol (LDL-C) in complex older patients is not well understood. OBJECTIVES:Determine correlates of adherence and examine the effect of meeting Star adherence targets on blood pressure and LDL-C in the Medicare-aged diabetes population. DESIGN AND SUBJECTS:Retrospective cohort study of 129,040 patients with diabetes aged 65 or older. MEASURES:Adherence estimated using proportion of days covered target ? 0.8; blood pressure < 140/90 mg Hg; LDL-C < 100 mg/dl. Modified Poisson regression used to assess relationships. RESULTS:Adherence differed little across elderly age groups. Compared to no comorbidity, high comorbidity (? 4) was associated with lower ACEI/ARB (risk ratio [RR] 0.88 [95% confidence interval (CI) 0.87-0.89]) or statin (RR 0.91 [0.90-0.92]) adherence. ACEI/ARB adherence was not associated with blood pressure < 140/90 mm Hg in patients ? 85 years (RR 1.01 [0.96-1.07]) or with multiple comorbidities (e.g., 3: RR 1.04 [0.99-1.08]). Statin adherence and LDL-C < 100 mg/dl were associated in all elderly age groups (e.g., ? 85: RR 1.13 [1.09-1.16]) and comorbidity levels (e.g., ? 4: RR 1.13 [1.12-1.15]). CONCLUSIONS:Adherence to ACEI/ARB is not linked with reduced blood pressure in patients with diabetes who are at least 85 years or with multiple comorbidities.

SUBMITTER: Raebel MA

PROVIDER: S-EPMC5647232 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Relationships between Medication Adherence and Cardiovascular Disease Risk Factor Control in Elderly Patients with Diabetes.

Raebel Marsha A MA Dyer Wendy W Nichols Gregory A GA Goodrich Glenn K GK Schmittdiel Julie A JA

Pharmacotherapy 20170912 10

<h4>Background</h4>The Centers for Medicare and Medicaid Services (CMS) Medicare Star program provides incentives to health plans when their patients with diabetes meet adherence targets to angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) and statins. While a link between adherence and cardiovascular risk factor control is established, most studies included young patients with few comorbidities. Whether the Star adherence target is associated with reduced bl ...[more]

PMID: 28752555

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Project description:IntroductionThe exact pathway linking health literacy, self-efficacy, medication adherence, and glycemic control for type 2 diabetes remains unclear. Understanding the relationship between patient factors, medication adherence, and lower glycated hemoglobin (HbA1c) may help patients better manage their disease. This study examined the association of health literacy and medication self-efficacy with self-reported diabetes medication adherence, and the association of health literacy, medication self-efficacy, and self-reported diabetes medication adherence with HbA1c of patients with type 2 diabetes.MethodsThis cross-sectional study utilized a face-to-face questionnaire at two family medicine clinics in a Midwestern state among 174 patients; subjects enrolled were at least 20 years old with diagnosed type 2 diabetes, prescribed at least one oral diabetes medicine, and understood English. Questionnaires were administered to assess the participants': health literacy, using the Newest Vital Sign six-item questionnaire (NVS); self-efficacy for medication use, using the 13-item Self-Efficacy for Appropriate Medication Use Scale; and self-report medication adherence, using the eight-item Morisky Medication Adherence Scale. HbA1c values were obtained from participants' electronic medical records. Multiple linear regressions were used to explore the association of health literacy and medication self-efficacy with both medication adherence and HbA1c level after controlling for all other covariates.ResultsSelf-reported health status (β = 0.17, p = 0.015) and medication self-efficacy (β = 0.53, p < 0.001) were positively associated with diabetes medication adherence. Health literacy was neither associated with diabetes medication adherence (β = -0.04, p = 0.586) nor HbA1c (β = -0.06, p = 0.542). Lower diabetes medication adherence (β = -0.26, p = 0.008) and higher number of prescribed medications (β = 0.28, p = 0.009) were correlated with higher HbA1c.ConclusionHealth literacy, as measured by the NVS, does not correlate with medication adherence or glycemic control among patients with type 2 diabetes. Interventions to improve patients' self-efficacy of medication use may improve diabetes medication adherence.

Project description:Background Medication nonadherence contributes to poor health outcomes but remains challenging to identify. This study assessed the association between self-rated adherence and systolic blood pressure, low-density lipoprotein cholesterol levels, cardiovascular events, and all-cause mortality in SPRINT (Systolic Blood Pressure Intervention Trial). Methods and Results A total of 9361 patients randomized to 2 systolic blood pressure target groups, <120 mm Hg (intensive) and <140 mm Hg (standard), self-rated their medication adherence at each visit by marking a scale, ranging from 0% to 100%. Lower and high adherence were defined as scores ≤80% and >80%, respectively. Linear mixed effect regression models and Cox proportional hazard models were used to evaluate the association between self-rated adherence and systolic blood pressure and low-density lipoprotein cholesterol and cardiovascular events and all-cause mortality, respectively. A total of 9278 participants (mean age 68±9.4 years, 35.6% female) had repeated self-rated adherence measurements available, with a mean of 15±4 measurements per participant over 3.8 years follow-up. Of these, 2694 participants (29.0%) had ≥1 adherence measurements ≤80%. Compared with high-adherent patients, patients with lower adherence had significantly higher estimated on-treatment systolic blood pressure at 2-year follow-up: 128.7 (95% CI, 127.6-129.9) versus 120.0 (95% CI, 119.7-120.2) mm Hg in the intensive arm; and 139.8 (95% CI 138.4-141.1) versus 135.0 (95% CI 134.7-135.2) in the standard arm. Moreover, lower adherence was associated with an estimated 11 mg/dL higher low-density lipoprotein cholesterol level, more cardiovascular events (hazard ratio [HR], 1.69 [95% CI, 1.20-2.39]), and higher all-cause mortality (HR, 1.63 [95% CI, 1.16-2.31]). Conclusions Self-rated adherence allows identification of lower medication adherence and correlates with blood pressure control, low-density lipoprotein cholesterol levels, and adverse outcomes.

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Relationships between Medication Adherence and Cardiovascular Disease Risk Factor Control in Elderly Patients with Diabetes.

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Relationships between Medication Adherence and Cardiovascular Disease Risk Factor Control in Elderly Patients with Diabetes.

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