Prescriber Continuity and Medication Adherence for Complex Patients

Richard A. Hansen, Corrine I. Voils, Joel F. Farley, Benjamin J. Powers, Linda L. Sanders, Betsy Sleath, Matthew L. Maciejewski

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: Medication adherence is a critical aspect of managing cardiometabolic conditions, including diabetes, hypertension, dyslipidemia, and heart failure. Patients who have multiple cardiometabolic conditions and multiple prescribers may be at increased risk for nonadherence. Objective: The purpose of this study was to examine the relationship between number of prescribers, number of conditions, and refill adherence to oral medications to treat cardiometabolic conditions. Methods: In this retrospective cohort study, 7933 veterans were identified with 1 to 4 cardiometabolic conditions. Refill adherence to oral medications for diabetes, hypertension, and dyslipidemia was measured using an administrative claims–based continuous multiple-interval gap (CMG) that estimates the percentage of days a patient did not possess medication. We dichotomized refill adherence for each condition as a CMG ≤20% for each year of analysis. Condition-specific logistic regression models estimated the relationship between refill adherence and number of cardiometabolic conditions and number of prescribers, controlling for demographic characteristics, other comorbidities, and a count of cardiometabolic drug classes used. Results: Compared with patients with 1 prescriber, antihypertensive refill adherence was lower in patients seeing ≥4 prescribers (odds ratio [OR] = 0.69; 95% CI = 0.59-0.80), but the number of cardiometabolic conditions was not a significant predictor. Antidyslipidemia refill adherence was lower in patients seeing 3 prescribers (OR = 0.80; 95% CI = 0.70-0.92) or ≥4 prescribers (OR = 0.77; 95% CI = 0.64-0.91). Conversely, antidyslipidemia refill adherence improved with the number of cardiometabolic conditions, but differences were only statistically significant for ≥3 conditions (OR = 1.31; 95% CI = 1.09-1.57). In multivariate regression models, the number of conditions and number of prescribers were not significant predictors of refill adherence in the group of patients with diabetes. Conclusions: Effective management of care and medication regimens for complex patients remains an unresolved challenge, but these results suggest that medication refill adherence might be improved by minimizing the number of prescribers involved in a patient’s care, at least for hypertension and dyslipidemia.

Original languageEnglish (US)
Pages (from-to)293-302
Number of pages10
JournalAnnals of Pharmacotherapy
Volume49
Issue number3
DOIs
StatePublished - Mar 26 2015

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Agency for Healthcare Research and Quality (R21 HS019445). This work was also supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs. Dr Maciejewski was also supported by a Research Career Scientist award from the Department of Veterans Affairs (RCS 10-391).

Publisher Copyright:
© The Author(s) 2014

Keywords

  • adherence
  • comorbidity
  • complex patient
  • multimorbidity
  • prescriber
  • provider
  • veterans

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