Medication Nonadherence Prevalent in Diabetics is Associated with Adverse Outcom

Medication nonadherence was significantly associated with increased risks for all-cause hospitalization and for all-cause mortality. As the association between medication nonadherence and mortality remains unexplored outside the context of clinical trials, researchers carried out a retrospective cohort study of 11 532 patients with diabetes in a managed care organization. Medication adherence was calculated as the proportion of days covered for filled prescriptions of oral hypoglycemics, antihypertensives, and statin medications. The primary outcomes of interest were all-cause hospitalization and all-cause mortality. Multivariable regression analyses were performed to assess the independent association between medication adherence and outcomes.

They found that nonadherent patients (proportion of days covered, <80%; prevalence, 21.3%) were younger and had fewer comorbidities compared with adherent patients. During follow-up, nonadherent patients had higher glycosylated hemoglobin, systolic and diastolic blood pressure, and low-density lipoprotein cholesterol levels. In unadjusted analyses, nonadherent patients had higher all-cause hospitalization (23.2% vs 19.2%, P<0.001) and higher all-cause mortality (5.9% vs 4.0%, P<0.001). In multivariable analyses, medication nonadherence remained significantly associated with increased risks for all-cause hospitalization (odds ratio, 1.58; P<0.001) and for all-cause mortality (odds ratio, 1.81; P<0.001). The findings were consistent across patient subgroups and using different cutoffs for the proportion of days covered.

The researchers concluded: “Medication nonadherence is prevalent among patients with diabetes mellitus and is associated with adverse outcomes. Interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.”

Nonadherence with medications is high among patients with diabetes mellitus, and results in adverse outcomes. Doctors need to check compliance at each visit.

Arch Intern Med. 2006;166:1836-1841. September 25, 2006. Effect of Medication Nonadherence on Hospitalization and Mortality Among Patients With Diabetes Mellitus

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DID YOU KNOW:
Due to Cost Issues 42% of Medicare Enrollees are Non-Compliant with Their Meds: Prior to implementation of the Medicare drug benefit, they found that in a national sample of 13 835 noninstitutionalized Medicare enrollees, 29% of the disabled and 13% of the elderly beneficiaries reported cost-related medication nonadherence; those in fair to poor health with multiple comorbidities and without coverage were most at risk. Among the disabled enrollees with 4 or more morbidities, 52% without drug coverage skipped prescriptions or doses compared with 26% with Medicaid drug coverage. Those with partial drug coverage through Medigap policies or Medicare health maintenance organizations reported intermediate rates of cost-related medication nonadherence. The rate of nonadherence to medications among the elderly and disabled, because of their cost, is alarming. When there is lack of improvement to therapy, nonadherence should be considered as a possible reason. Arch Intern Med. 2006;166:1829-1835. September 25, 2006.