Hypoglycemic drug utilization and adherence to prescribed regimens: A pharmacoepidemiologic study using retail pharmacy data
Background. Success in achieving tight blood glucose control is contingent upon adherence to the prescribed hypoglycemic drug regimen. ^ Objectives. The objectives of this study were (a) to describe hypoglycemic drug utilization, and compare drug regimens prescribed and costs among groups; (b) to explore the association between nonadherence and change in the strength or type of hypoglycemic medication prescribed; and (c) to compare adherence among patients who are prescribed monotherapy with a sulfonylurea or metformin with those prescribed dual therapy with both medications. ^ Methods. Cross-sectional and retrospective cohort studies were conducted. Analyses were performed using retail pharmacy data. A sample of 2901 diabetic patients was identified. Adherence was determined by measuring medication possession. ^ Results. Sulfonylurea users who failed to possess medication for at least 80% of days were 41.7% more likely to receive a dispensing for a different strength of medication in subsequent months (OR 1.42, 95% CI 1.02–1.96). Among patients receiving either monotherapy with a sulfonylurea or metformin, those possessing medication for less than 80% of days were 36.4% more likely to receive a dispensing for a different strength of medication (OR 1.36, 95% CI 1.019–1.83), or for a different strength or type of hypoglycemic medication (OR 1.39, 95% CI 1.03–1.87). ^ In multivariate analyses controlling for age and the total number of dispensings, patients receiving dual therapy with a sulfonylurea plus metformin were more than 3 times more likely to fail to possess medication for at least 80% of days (OR 3.14, 95% CI 2.42–4.08), or 90% of days (OR 3.20, 95% CI 2.49–4.11). ^ Conclusion. A substantial percentage of patients were found to be nonadherent with hypoglycemic drug therapy. Patients least frequently adherent to drug therapy included those under 65 years of age and those prescribed dual therapy with a sulfonylurea plus metformin. Presuming that lack of medication possession results in poor glucose control, patients who do not possess medication are at increased risk for diabetic complications. ^
Health Sciences, Pharmacy
Stephen Jon Kogut,
"Hypoglycemic drug utilization and adherence to prescribed regimens: A pharmacoepidemiologic study using retail pharmacy data"
Dissertations and Master's Theses (Campus Access).