Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

被引:14
|
作者
Lafata, Jennifer Elston [1 ,2 ,14 ]
Karter, Andrew J. [3 ]
O'Connor, Patrick J. [4 ]
Morris, Heather [5 ]
Schmittdiel, Julie A. [3 ]
Ratliff, Scott [1 ]
Newton, Katherine M. [6 ]
Raebel, Marsha A. [7 ,8 ]
Pathak, Ram D. [9 ]
Thomas, Abraham [10 ]
Butler, Melissa G. [11 ]
Reynolds, Kristi [12 ]
Waitzfelder, Beth [13 ]
Steiner, John F. [7 ]
机构
[1] Virginia Commonwealth Univ, Sch Med, Richmond, VA 23298 USA
[2] Henry Ford Hlth Syst, Detroit, MI USA
[3] Kaiser Permanente No Calif, Div Res, Oakland, CA USA
[4] HealthPartners Inst Educ & Res, Minneapolis, MN USA
[5] Univ Florida, Gainesville, FL USA
[6] Grp Hlth Res Inst, Seattle, WA USA
[7] Kaiser Permanente Colorado Inst Hlth Res, Denver, CO USA
[8] Univ Colorado, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO USA
[9] Marshfield Clin Fdn Med Res & Educ, Marshfield, WI USA
[10] Lutheran HealthCare, Brooklyn, NY USA
[11] Kaiser Permanente Georgia Ctr Hlth Research South, Atlanta, GA USA
[12] Kaiser Permanente So Calif, Dept Res & Evaluat, Los Angeles, CA USA
[13] Kaiser Permanente Hawaii, Ctr Hlth Res Hawaii, Honolulu, HI USA
[14] Virginia Commonwealth Univ, Dept Social & Behav Hlth, POB 980149, Richmond, VA 23298 USA
基金
美国医疗保健研究与质量局;
关键词
diabetes care; racial disparities; medication adherence; cardiometabolic risk factors; BLOOD-PRESSURE CONTROL; CLINICAL INERTIA; GLYCEMIC CONTROL; MULTIFACTORIAL INTERVENTION; RACIAL DISPARITIES; DRUG-THERAPY; HEALTH-CARE; INTENSIFICATION; MANAGEMENT; QUALITY;
D O I
10.1007/s11606-015-3486-0
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BACKGROUND: Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. METHODS: We identified three cohorts of black and white patients treated with oral medications and who had poor risk factor control at baseline (2009): those with glycated hemoglobin (HbA1c) >8 % (n=37,873), low-density lipoprotein cholesterol (LDL-C) >100 mg/dl (n=27,954), and systolic blood pressure (SBP) >130 mm Hg (n=63,641). Subjects included insured adults with diabetes who were receiving care in one of nine U.S. integrated health systems comprising the SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) consortium. Baseline and follow-up risk factor control, sociodemographic, and clinical characteristics were obtained from electronic health records. Pharmacy-dispensing data were used to estimate medication adherence (i.e., medication refill adherence [MRA]) and treatment intensification (i.e., dose increase or addition of new medication class) between baseline and follow-up. County-level income and educational attainment were estimated via geocoding. Logistic regression models were used to test the association between race and follow-up risk factor control. Models were specified with and without medication adherence to evaluate its role as a mediator. RESULTS: We observed poorer medication adherence among black patients than white patients (p<0.01): 50.6 % of blacks versus 39.7 % of whites were not highly adherent (i.e., MRA <80 %) to HbA1c oral medication(s); 58.4 % of blacks and 46.7 % of whites were not highly adherent to lipid medication(s); and 33.4 % of blacks and 23.7 % of whites were not highly adherent to BP medication( s). Across all cardiometabolic risk factors, blacks were significantly less likely to achieve control (p<0.01): 41.5 % of blacks and 45.8 % of whites achieved HbA1c <8 %; 52.6% of blacks and 60.8% ofwhites achieved LDL-C <100; and 45.7 % of blacks and 53.6 % of whites achieved SBP <130. Adjusting for medication adherence/treatment intensification did not alter these patterns or model fit statistics. CONCLUSIONS: Medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.
引用
收藏
页码:188 / 195
页数:8
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