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Factors associated with Primary Medication Non-adherence and its effect on Health Service Utilization among Medicare Beneficiaries with Cardiovascular disease

Gangan, Nilesh
http://rave.ohiolink.edu/etdc/view?acc_num=mco1384537938

Abstract Details

2013, Master of Science in Pharmaceutical Science (MSP), University of Toledo, College of Pharmacy.
Medication non-adherence is commonly seen among patients with cardiovascular disease. However, failure to fill prescriptions, a type of medication non-adherence, is rarely studied among these patients. Failure to fill prescriptions, also known as primary medication non-adherence (PMN), can lead to progression of disease condition and adverse outcomes which can ultimately increase healthcare costs. Therefore, it is important for patients, especially who are newly diagnosed with cardiovascular disease to fill their prescriptions. The incidence of cardiovascular disease is higher in elderly population. Hence, elderly population is susceptible to PMN, but little is known about the extent of PMN for this population and its impact on health service utilization. Recent healthcare reform emphasizes on giving high quality care to elderly patients with chronic conditions such as cardiovascular disease. Since medication adherence is a quality measure for healthcare service received by this population, efforts should be made in identifying ways to improve PMN. Hence, the objective of this study is to measure the rate of PMN, assess reasons and factors that are associated with PMN and compare health service utilization behavior between adherent and non-adherent Medicare covered elderly population with newly diagnosed cardiovascular disease. This was a cross-sectional cohort study of Medicare beneficiaries with newly diagnosed cardiovascular disease using Medicare Current beneficiaries Survey (MCBS) files from 2002 to 2006. Andersen’s model of health service utilization was used as a theoretical framework to define factors that may be associated with PMN. Seven thousand five hundred and forty-two Medicare beneficiaries were newly diagnosed with cardiovascular disease from years 2002 to 2006. Out of these, 334 patients did not fill prescriptions which represented 4.43% of the cohort under study. Female gender (OR 0.682, 95% CI 0.522-0.890), lower patient satisfaction score on overall health service (OR 1.074, 95% CI 1.040-1.109), low Charlson comorbidity score (OR 1.074, 95% CI 1.000-1.155) and higher cardiovascular burden (OR 1.248, 95% CI 1.122-1.388) was significantly associated with PMN. The most common reasons given by the patient for PMN were related to enabling factors and personal perceptions. Non-adherent patients had lesser physician visits (p<0.0001) and outpatient visits (p<0.0001) but higher ER visits (p<0.0001) and hospitalizations (p<0.0001) than adherent patients. Many patients failed to fill their prescriptions showing PMN among the study population. PMN was particularly significant in females, patients having low satisfaction with health service received, patients with low Charlson comorbidity score and patients with higher number of cardiovascular conditions. With the recent healthcare reform targeted at improving overall quality of care, findings from present study provide guidance towards identifying populations vulnerable to PMN. PMN is a much severe issue especially in case of chronic conditions such as cardiovascular diseases than the secondary adherence. A comprehensive approach involving physician-pharmacists collaborations could lead to develop interventions such as appropriate counseling designed to eliminate PMN. Future research should focus on identifying more factors leading to causality of PMN and devise strategies to reduce prevalence of PMN.
Varun Vaidya, PhD (Committee Chair)
Sharrel Pinto, PhD (Committee Member)
Aliaksandr Amialchuk, PhD (Committee Member)
83 p.
Health Care; Pharmacy Sciences; Social Research
Primary Medication Non-adherence; Cardiovascular disease; Medicare beneficiaries; Health Service Utilization; Patient Satisfaction; Patient related factors

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Citations

  • Gangan, N. (2013). Factors associated with Primary Medication Non-adherence and its effect on Health Service Utilization among Medicare Beneficiaries with Cardiovascular disease [Master's thesis, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=mco1384537938

    APA Style (7th edition)

  • Gangan, Nilesh. Factors associated with Primary Medication Non-adherence and its effect on Health Service Utilization among Medicare Beneficiaries with Cardiovascular disease. 2013. University of Toledo, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=mco1384537938.

    MLA Style (8th edition)

  • Gangan, Nilesh. "Factors associated with Primary Medication Non-adherence and its effect on Health Service Utilization among Medicare Beneficiaries with Cardiovascular disease." Master's thesis, University of Toledo, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=mco1384537938

    Chicago Manual of Style (17th edition)

mco1384537938
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This open access ETD is published by University of Toledo Health Science Campus and OhioLINK.