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Predictors and consequences of nonadherence to antihypertensive medication
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Predictors and consequences of nonadherence to antihypertensive medication
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Sharma
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Puza P.
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Puza P. Sharma
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Rutgers University
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Graduate School - New Brunswick
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theses
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2007
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2007
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English
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electronic
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x, 104 pages
Abstract
Context: Nonadherence to antihypertensive therapy attributes to uncontrolled blood pressure. This may worsen the severity of hypertension and ultimately increase health care costs. This underlines the importance of identifying predictors and consequences of nonadherence to antihypertensive therapy.
Objectives: (I) To empirically determine the length of gap between antihypertensive prescription refills that predicts long term prescription discontinuation. This gap can be used to define antihypertensive medication nonadherence. (II) To examine predictors of nonadherence and (III) To evaluate the role of nonadherence on rates of hospitalization and emergency room visits.
Design, settings and subjects: For Objectives I and II, retrospective cohort designs were employed on 51,615 subjects enrolled in a large United States pharmacy benefit manager during Jan 1st 2003 and May 31st 2006. Subjects were included if they had [greater than or equal to] 2 prescriptions of antihypertensive medication, were new users and were [greater than or equal to] 30 years. For Objective III, a cross-sectional design was employed on 9,945 subjects aged 30-64 years continuously enrolled in New Jersey Medicaid between Jan 1999 and Dec 2001.
For Objective I, Receiver Operating Characteristics (ROC) analysis was performed using maximum gap in anti hypertensive therapy as a predictor of long term treatment discontinuation. For Objective II, time to nonadherence was analyzed with the use of Cox Proportional Hazard Regression model. For Objective III, Log-Linear Regression analysis was utilized to estimate the risk of health care utilization associated with nonadherence
Results: For Objective I, ROC analysis generated a C-statistic of 0.87. The cut-off value for maximum gap between refills that optimized sensitivity (0.81) and specificity (0.79) was 75 days. For Objective II, region of the country in which the subjects resided and subjects living in a census block with high percentage of African American population and low levels of income were found to be significant predictors of nonadherence. Subjects who were treated by cardiologists and younger physicians also had improved adherence. Objective III showed that subjects who were nonadherent to antihypertensive therapy had significantly higher rates of hospitalizations as well as emergency visits.
Conclusion: Timely corrective interventions to improve adherence will have significant impact on the cost-effectiveness in the treatment of hypertension.
Objectives: (I) To empirically determine the length of gap between antihypertensive prescription refills that predicts long term prescription discontinuation. This gap can be used to define antihypertensive medication nonadherence. (II) To examine predictors of nonadherence and (III) To evaluate the role of nonadherence on rates of hospitalization and emergency room visits.
Design, settings and subjects: For Objectives I and II, retrospective cohort designs were employed on 51,615 subjects enrolled in a large United States pharmacy benefit manager during Jan 1st 2003 and May 31st 2006. Subjects were included if they had [greater than or equal to] 2 prescriptions of antihypertensive medication, were new users and were [greater than or equal to] 30 years. For Objective III, a cross-sectional design was employed on 9,945 subjects aged 30-64 years continuously enrolled in New Jersey Medicaid between Jan 1999 and Dec 2001.
For Objective I, Receiver Operating Characteristics (ROC) analysis was performed using maximum gap in anti hypertensive therapy as a predictor of long term treatment discontinuation. For Objective II, time to nonadherence was analyzed with the use of Cox Proportional Hazard Regression model. For Objective III, Log-Linear Regression analysis was utilized to estimate the risk of health care utilization associated with nonadherence
Results: For Objective I, ROC analysis generated a C-statistic of 0.87. The cut-off value for maximum gap between refills that optimized sensitivity (0.81) and specificity (0.79) was 75 days. For Objective II, region of the country in which the subjects resided and subjects living in a census block with high percentage of African American population and low levels of income were found to be significant predictors of nonadherence. Subjects who were treated by cardiologists and younger physicians also had improved adherence. Objective III showed that subjects who were nonadherent to antihypertensive therapy had significantly higher rates of hospitalizations as well as emergency visits.
Conclusion: Timely corrective interventions to improve adherence will have significant impact on the cost-effectiveness in the treatment of hypertension.
Note
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Ph.D.
Note
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Includes bibliographical references.
Subject
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Topic
Public Health
Subject
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Topic
Hypertension--Treatment
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Topic
Patient compliance
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Graduate School - New Brunswick Electronic Theses and Dissertations
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doi:10.7282/T3D50NCB
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ETD doctoral
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Puza Sharma
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Rutgers University. Graduate School - New Brunswick
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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