- Title
- Racial differences in oral antidiabetic medication adherence, healthcare utilization and costs associated with type 2 diabetes in medicaid enrollees
- Author
- Shenolikar, Rahul
- Degree
- Doctor of Philosophy, Ohio State University,
Pharmacy, 2006.
- Advisor
- Rajesh Balkrishnan
- Abstract
- The prevalence of diabetes is higher in Non-Hispanic Blacks, and Hispanics as compared to non-Hispanic Whites. Adherence to medications is required in achieving glycemic control as it has a well established relationship with improved treatment outcomes and is associated with decreased utilization of medical resources. This study examined the racial differences in medication adherence and associated healthcare costs and utilization. A modified version of Health Belief Model and Aday-Andersen model for healthcare utilization was used as the theoretical model. This retrospective cohort study which used North Carolina Medicaid database compared 1517 African Americans, 1115 Whites and 505 patients of other races newly starting metformin, sulfonylureas or thiazolidiendiones. The patients were followed for one year after the start of medication to gather the data on medication utilization, healthcare costs, hospitalization and emergency room visits. Demographic, clinical and medication related information was extracted from the database. Multiple log-linear regression analysis was employed to model medication adherence and healthcare costs, while multiple logistic regression analysis was utilized for hospitalization, and emergency room visits. Adherence levels of this population were considerably lower than the generally accepted level of eighty percent. The study found that there were racial differences in medication adherence, healthcare costs, likelihood of hospitalizations and emergency room visits. Being an African American was associated with decreased medication adherence, increased healthcare costs, increased likelihood of hospitalization and emergency room visit as compared to Whites. Factors such as age, comorbidities, and number of medications consumed were also significant predictors of outcomes. Medication adherence was mainly associated with hospitalization and ER visit, which reinforces the importance of adherence in avoiding complications in diabetes patients. The predictive power of the models explaining adherence was moderate, while models explained variance in healthcare costs considerably well. Third-party payers such as Medicaid need to target at-risk patients based on the above mentioned factors. Disease management programs remain the most important tool to target at-risk patients, consider their clinical profile and medication management issues for optimal utilization of healthcare resources.
Document number: osu1156948396.
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