Pharmacy Claims Data Useful Gauge of Diabetic Drug Adherence

Adherence to medication, measured by prescription drug claims data, is associated with intermediate clinical outcomes and may therefore be useful in clinical practice.

Clinicians, writing in the December issue of Diabetes Care, conclude that "more research is needed on methods to introduce claims-based adherence measurements into routine clinical practice and how to use these measurements to effectively improve adherence and health outcomes in chronic care management."

Dr. Manel Pladevall and others from the Henry Ford Health System in Detroit, Michigan used prescription drug claims data to determine adherence to antidiabetic, lipid-lowering, and antihypertensive medication in 677 randomly selected adults with diabetes, hypercholesterolemia and hypertension.

"Nonadherent patients had both statistically and clinically worse outcomes than adherent patients," they report. In adjusted analyses, nonadherence to prescribed medication was significantly associated with higher HbA1c levels and higher LDL cholesterol levels.

According to the team, a 10% increase in nonadherence to metformin and statins was associated with a 0.14% increase in HbA1c and a 4.9 mg/dL increase in LDL cholesterol.

There was no apparent relationship between nonadherence to ACE inhibitor therapy and blood pressure, although most patients prescribed an ACE inhibitor took their medication as prescribed.

This study, Dr. Pladevall and colleagues note, highlights the potential value of claims-based data to improve both medication adherence and relevant clinical outcomes.

"Unless feasible adherence measurements are introduced into routine clinical practice, the status quo of low adherence levels and the unavailability of effective tools to improve medication adherence is likely to remain unchallenged," they warn.
Diabetes Care 2004;27:2800-2805.

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