Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy
Background: Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented. Objective: This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who we...
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| Veröffentlicht in: | Clinical therapeutics 2002-03, Vol.24 (3), p.460-467 |
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| creator | Melikian, Caron White, T.Jeffrey Vanderplas, Ann Dezii, Christopher M. Chang, Eunice |
| description | Background:
Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented.
Objective:
This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who were receiving antidiabetic monotherapy (metformin or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination therapy (glyburide/metformin).
Methods:
Medication adherence was evaluated through a retrospective database analysis of pharmacy claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic medication obtained by the patient during the follow-up period divided by the total number of days in the designated follow-up period (180 days). Health plan members were included in the analysis if they had an index pharmacy claim for an oral antidiabetic medication between August 1 and December 31, 2000, were continuously enrolled in the health plan, and were aged ≥18 years. A 6-month pre-index period was used to classify patients as newly treated or previously treated. Patients were grouped according to their medication-use patterns.
Results:
After adjustment for potential confounding factors, including overall medication burden at index, there were no significant differences in adherence rates among 6502 newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination therapy. Among the 1815 previously treated patients receiving glyburide or metformin monotherapy who required the addition of the alternative agent, resulting in combination therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52–0.55) than in the 105 patients receiving monotherapy who were switched to fixed-dose combination therapy (77.0%; 95% CI, 0.72–0.82). The 59 previously treated patients receiving combination therapy who were switched to fixed-dose combination therapy had a significant improvement in adherence after the switch (71.0% vs 87.0%;
P < 0.001).
Conclusions:
In a managed care organization, previously treated patients receiving monotherapy with an oral antidiabetic medication who required additional therapy exhibited significantly greater adherence when they were switched to fixed-dose combination therapy compared with combination therapy. Patients receiving combination therapy who were switched to fixed-dose combination therapy exhibited significantly greater adherence after the switch |
| doi_str_mv | 10.1016/S0149-2918(02)85047-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71596349</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0149291802850470</els_id><sourcerecordid>71596349</sourcerecordid><originalsourceid>FETCH-LOGICAL-c509t-4304e53d8fcba7adb21723e86056765f53d8b3764c7e5fc7bbb66bd287df05363</originalsourceid><addsrcrecordid>eNqFkU2L1TAUhoMozp3Rn6BkoyhYTZomad3IZfALBlyo4C6cJKdjpE2uSa84_pX5s7b3lpmN4OpA3udNwnkIecTZS864evWZ8aar6o63z1j9vJWs0RW7Qza81V3FefPtLtncICfktJQfjDHRyfo-OeF8nqzuNuR6679jxuiQTommDAOFOAUfwOIUHJ3mFHZXNEQKdIQIl-ipg4wzewkx_IEppPiabqlL4w5yKCnS1NMxxbR2XyyRDfFA0ptDiJ724Tf6yqeC_2IekHs9DAUfrvOMfH339sv5h-ri0_uP59uLyknWTVUjWINS-LZ3FjR4W3NdC2wVk0or2S-RFVo1TqPsnbbWKmV93WrfMymUOCNPj_fucvq5xzKZMRSHwwAR074YzWWnRNPNoDyCLqdSMvZml8MI-cpwZhYr5mDFLCs3rDYHK4bNvcfrA3s7or9trRpm4MkKQHEw9BmiC-WWE7LTSizcmyOH8zp-BcymuLDI8yGjm4xP4T9f-Qsv-6yI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>71596349</pqid></control><display><type>article</type><title>Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Melikian, Caron ; White, T.Jeffrey ; Vanderplas, Ann ; Dezii, Christopher M. ; Chang, Eunice</creator><creatorcontrib>Melikian, Caron ; White, T.Jeffrey ; Vanderplas, Ann ; Dezii, Christopher M. ; Chang, Eunice</creatorcontrib><description>Background:
Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented.
Objective:
This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who were receiving antidiabetic monotherapy (metformin or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination therapy (glyburide/metformin).
Methods:
Medication adherence was evaluated through a retrospective database analysis of pharmacy claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic medication obtained by the patient during the follow-up period divided by the total number of days in the designated follow-up period (180 days). Health plan members were included in the analysis if they had an index pharmacy claim for an oral antidiabetic medication between August 1 and December 31, 2000, were continuously enrolled in the health plan, and were aged ≥18 years. A 6-month pre-index period was used to classify patients as newly treated or previously treated. Patients were grouped according to their medication-use patterns.
Results:
After adjustment for potential confounding factors, including overall medication burden at index, there were no significant differences in adherence rates among 6502 newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination therapy. Among the 1815 previously treated patients receiving glyburide or metformin monotherapy who required the addition of the alternative agent, resulting in combination therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52–0.55) than in the 105 patients receiving monotherapy who were switched to fixed-dose combination therapy (77.0%; 95% CI, 0.72–0.82). The 59 previously treated patients receiving combination therapy who were switched to fixed-dose combination therapy had a significant improvement in adherence after the switch (71.0% vs 87.0%;
P < 0.001).
Conclusions:
In a managed care organization, previously treated patients receiving monotherapy with an oral antidiabetic medication who required additional therapy exhibited significantly greater adherence when they were switched to fixed-dose combination therapy compared with combination therapy. Patients receiving combination therapy who were switched to fixed-dose combination therapy exhibited significantly greater adherence after the switch.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/S0149-2918(02)85047-0</identifier><identifier>PMID: 11952029</identifier><language>eng</language><publisher>Belle Mead, NJ: EM Inc USA</publisher><subject>adherence ; Administration, Oral ; Aged ; Biological and medical sciences ; compliance ; Databases, Factual ; diabetes mellitus ; Drug Therapy, Combination ; Female ; fixed-dose combination therapy ; General and cellular metabolism. Vitamins ; Glyburide - administration & dosage ; Glyburide - therapeutic use ; Humans ; Hypoglycemic Agents - therapeutic use ; Male ; Managed Care Programs ; Medical sciences ; Metformin - administration & dosage ; Metformin - therapeutic use ; Middle Aged ; oral antidiabetic medication ; Patient Compliance ; Pharmacology. Drug treatments ; Retrospective Studies</subject><ispartof>Clinical therapeutics, 2002-03, Vol.24 (3), p.460-467</ispartof><rights>2002</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-4304e53d8fcba7adb21723e86056765f53d8b3764c7e5fc7bbb66bd287df05363</citedby><cites>FETCH-LOGICAL-c509t-4304e53d8fcba7adb21723e86056765f53d8b3764c7e5fc7bbb66bd287df05363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0149291802850470$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13597639$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11952029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Melikian, Caron</creatorcontrib><creatorcontrib>White, T.Jeffrey</creatorcontrib><creatorcontrib>Vanderplas, Ann</creatorcontrib><creatorcontrib>Dezii, Christopher M.</creatorcontrib><creatorcontrib>Chang, Eunice</creatorcontrib><title>Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>Background:
Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented.
Objective:
This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who were receiving antidiabetic monotherapy (metformin or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination therapy (glyburide/metformin).
Methods:
Medication adherence was evaluated through a retrospective database analysis of pharmacy claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic medication obtained by the patient during the follow-up period divided by the total number of days in the designated follow-up period (180 days). Health plan members were included in the analysis if they had an index pharmacy claim for an oral antidiabetic medication between August 1 and December 31, 2000, were continuously enrolled in the health plan, and were aged ≥18 years. A 6-month pre-index period was used to classify patients as newly treated or previously treated. Patients were grouped according to their medication-use patterns.
Results:
After adjustment for potential confounding factors, including overall medication burden at index, there were no significant differences in adherence rates among 6502 newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination therapy. Among the 1815 previously treated patients receiving glyburide or metformin monotherapy who required the addition of the alternative agent, resulting in combination therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52–0.55) than in the 105 patients receiving monotherapy who were switched to fixed-dose combination therapy (77.0%; 95% CI, 0.72–0.82). The 59 previously treated patients receiving combination therapy who were switched to fixed-dose combination therapy had a significant improvement in adherence after the switch (71.0% vs 87.0%;
P < 0.001).
Conclusions:
In a managed care organization, previously treated patients receiving monotherapy with an oral antidiabetic medication who required additional therapy exhibited significantly greater adherence when they were switched to fixed-dose combination therapy compared with combination therapy. Patients receiving combination therapy who were switched to fixed-dose combination therapy exhibited significantly greater adherence after the switch.</description><subject>adherence</subject><subject>Administration, Oral</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>compliance</subject><subject>Databases, Factual</subject><subject>diabetes mellitus</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>fixed-dose combination therapy</subject><subject>General and cellular metabolism. Vitamins</subject><subject>Glyburide - administration & dosage</subject><subject>Glyburide - therapeutic use</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Male</subject><subject>Managed Care Programs</subject><subject>Medical sciences</subject><subject>Metformin - administration & dosage</subject><subject>Metformin - therapeutic use</subject><subject>Middle Aged</subject><subject>oral antidiabetic medication</subject><subject>Patient Compliance</subject><subject>Pharmacology. Drug treatments</subject><subject>Retrospective Studies</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU2L1TAUhoMozp3Rn6BkoyhYTZomad3IZfALBlyo4C6cJKdjpE2uSa84_pX5s7b3lpmN4OpA3udNwnkIecTZS864evWZ8aar6o63z1j9vJWs0RW7Qza81V3FefPtLtncICfktJQfjDHRyfo-OeF8nqzuNuR6679jxuiQTommDAOFOAUfwOIUHJ3mFHZXNEQKdIQIl-ipg4wzewkx_IEppPiabqlL4w5yKCnS1NMxxbR2XyyRDfFA0ptDiJ724Tf6yqeC_2IekHs9DAUfrvOMfH339sv5h-ri0_uP59uLyknWTVUjWINS-LZ3FjR4W3NdC2wVk0or2S-RFVo1TqPsnbbWKmV93WrfMymUOCNPj_fucvq5xzKZMRSHwwAR074YzWWnRNPNoDyCLqdSMvZml8MI-cpwZhYr5mDFLCs3rDYHK4bNvcfrA3s7or9trRpm4MkKQHEw9BmiC-WWE7LTSizcmyOH8zp-BcymuLDI8yGjm4xP4T9f-Qsv-6yI</recordid><startdate>20020301</startdate><enddate>20020301</enddate><creator>Melikian, Caron</creator><creator>White, T.Jeffrey</creator><creator>Vanderplas, Ann</creator><creator>Dezii, Christopher M.</creator><creator>Chang, Eunice</creator><general>EM Inc USA</general><general>Excerpta Medica</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20020301</creationdate><title>Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy</title><author>Melikian, Caron ; White, T.Jeffrey ; Vanderplas, Ann ; Dezii, Christopher M. ; Chang, Eunice</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-4304e53d8fcba7adb21723e86056765f53d8b3764c7e5fc7bbb66bd287df05363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>adherence</topic><topic>Administration, Oral</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>compliance</topic><topic>Databases, Factual</topic><topic>diabetes mellitus</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>fixed-dose combination therapy</topic><topic>General and cellular metabolism. Vitamins</topic><topic>Glyburide - administration & dosage</topic><topic>Glyburide - therapeutic use</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Male</topic><topic>Managed Care Programs</topic><topic>Medical sciences</topic><topic>Metformin - administration & dosage</topic><topic>Metformin - therapeutic use</topic><topic>Middle Aged</topic><topic>oral antidiabetic medication</topic><topic>Patient Compliance</topic><topic>Pharmacology. Drug treatments</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Melikian, Caron</creatorcontrib><creatorcontrib>White, T.Jeffrey</creatorcontrib><creatorcontrib>Vanderplas, Ann</creatorcontrib><creatorcontrib>Dezii, Christopher M.</creatorcontrib><creatorcontrib>Chang, Eunice</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Melikian, Caron</au><au>White, T.Jeffrey</au><au>Vanderplas, Ann</au><au>Dezii, Christopher M.</au><au>Chang, Eunice</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2002-03-01</date><risdate>2002</risdate><volume>24</volume><issue>3</issue><spage>460</spage><epage>467</epage><pages>460-467</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>Background:
Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented.
Objective:
This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who were receiving antidiabetic monotherapy (metformin or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination therapy (glyburide/metformin).
Methods:
Medication adherence was evaluated through a retrospective database analysis of pharmacy claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic medication obtained by the patient during the follow-up period divided by the total number of days in the designated follow-up period (180 days). Health plan members were included in the analysis if they had an index pharmacy claim for an oral antidiabetic medication between August 1 and December 31, 2000, were continuously enrolled in the health plan, and were aged ≥18 years. A 6-month pre-index period was used to classify patients as newly treated or previously treated. Patients were grouped according to their medication-use patterns.
Results:
After adjustment for potential confounding factors, including overall medication burden at index, there were no significant differences in adherence rates among 6502 newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination therapy. Among the 1815 previously treated patients receiving glyburide or metformin monotherapy who required the addition of the alternative agent, resulting in combination therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52–0.55) than in the 105 patients receiving monotherapy who were switched to fixed-dose combination therapy (77.0%; 95% CI, 0.72–0.82). The 59 previously treated patients receiving combination therapy who were switched to fixed-dose combination therapy had a significant improvement in adherence after the switch (71.0% vs 87.0%;
P < 0.001).
Conclusions:
In a managed care organization, previously treated patients receiving monotherapy with an oral antidiabetic medication who required additional therapy exhibited significantly greater adherence when they were switched to fixed-dose combination therapy compared with combination therapy. Patients receiving combination therapy who were switched to fixed-dose combination therapy exhibited significantly greater adherence after the switch.</abstract><cop>Belle Mead, NJ</cop><pub>EM Inc USA</pub><pmid>11952029</pmid><doi>10.1016/S0149-2918(02)85047-0</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-2918 |
| ispartof | Clinical therapeutics, 2002-03, Vol.24 (3), p.460-467 |
| issn | 0149-2918 1879-114X |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | adherence Administration, Oral Aged Biological and medical sciences compliance Databases, Factual diabetes mellitus Drug Therapy, Combination Female fixed-dose combination therapy General and cellular metabolism. Vitamins Glyburide - administration & dosage Glyburide - therapeutic use Humans Hypoglycemic Agents - therapeutic use Male Managed Care Programs Medical sciences Metformin - administration & dosage Metformin - therapeutic use Middle Aged oral antidiabetic medication Patient Compliance Pharmacology. Drug treatments Retrospective Studies |
| title | Adherence to oral antidiabetic therapy in a managed care organization: A comparison of monotherapy, combination therapy, and fixed-dose combination therapy |
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