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© 2004 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Clinical Outcomes and Adherence to Medications Measured by Claims Data in Patients With Diabetes
1 Center for Health Services Research, Henry Ford Health System, Detroit, Michigan
2 College of Pharmacy, University of Michigan, Ann Arbor, Michigan
3 Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan
Address correspondence and reprint requests to Dr. Manel Pladevall, MD, MS, Center for Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, Michigan 48202. E-mail: mpladev1{at}hfhs.org
OBJECTIVE—Although poor medication adherence may contribute to inadequate diabetes control, ways to feasibly measure adherence in routine clinical practice have yet to be established. The present study was conducted to determine whether pharmacy claims-based measures of medication adherence are associated with clinical outcomes in patients with diabetes.
RESEARCH DESIGN AND METHODS—The study setting was a large, integrated delivery and financial system serving the residents of southeastern Michigan. The study population consisted of 677 randomly selected patients aged 
18 years with a diagnosis of diabetes, hypercholesterolemia, and hypertension and who filled at least one prescription for either an antidiabetic, lipid-lowering, or antihypertensive drug in each of the 3 study years (1999–2001). The main outcome measures were HbA1c, LDL cholesterol levels, and blood pressure.
RESULTS—Nonadherent patients had both statistically and clinically worse outcomes than adherent patients. Even after adjusting for demographic and clinical characteristics, nonadherence was significantly associated with HbA1c and LDL cholesterol levels. A 10% increase in nonadherence to metformin and statins was associated with an increase of 0.14% in HbA1c and an increase of 4.9 mg/dl in LDL cholesterol levels. Nonadherence to ACE inhibitors was not significantly associated with blood pressure.
CONCLUSIONS—Claims-based measures of medication adherence are associated with clinical outcomes in patients with diabetes and may therefore prove to be useful in clinical practice. 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.
Abbreviations: CMG, continuous measure of medication gaps • SBP, systolic blood pressure
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