Key result
Each 10% increase in antihypertensive refill-adherence measured by proportion of days covered was associated with a 16% lower rate of hospital visits (adjusted IRR 0.84; 95% CI 0.72-0.98; P=0.036).
Why the study?
Methods to target adherence interventions are needed, prompting investigation into whether community pharmacy refill-adherence metrics identify patients at higher risk of healthcare utilisation from low antihypertensive adherence.
Does higher antihypertensive medication adherence measured by pharmacy refill metrics reduce healthcare utilisation in older hypertensive adults?
Cohort (n=905)
Yes
Does higher antihypertensive medication adherence measured by pharmacy refill metrics reduce healthcare utilisation in older hypertensive adults?
Effect estimate: adjusted incidence rate ratio 0.84 (95% CI 0.72-0.98)
p-value: p=0.036
Higher antihypertensive medication adherence, measured by proportion of days covered (PDC) in community pharmacies, is associated with significantly lower rates of hospital and GP visits in older adults.
Supports pharmacy refill monitoring in older hypertensives; leaves open whether adherence interventions reduce utilisation.
AIMS: Methods that enable targeting and tailoring of adherence interventions may facilitate implementation in clinical settings. We aimed to determine whether community pharmacy refill-adherence metrics are useful to identify patients at higher risk of healthcare utilisation due to low antihypertensive adherence, who may benefit from an adherence intervention. METHODS: We conducted a prospective cohort study, recruiting participants (n = 905) from 106 community pharmacies across the Republic of Ireland. Participants completed a structured interview at baseline and 12 months. Antihypertensive medication adherence was evaluated from linked pharmacy records using group-based trajectory modelling (GBTM) and proportion of days covered (PDC). Healthcare utilisation included self-reported number of hospital visits (emergency department visits and inpatient admissions) and general practitioner (GP) visits, over a 6-month period. Separate regression models were used to estimate the association between adherence and number of hospital/GP visits. The relative statistical fit of each model using different adherence metrics was determined using the Bayesian information criterion (BIC). RESULTS: For the number of hospital visits, significant associations were observed only for PDC but not for GBTM. Each 10% increase in refill-adherence by PDC was significantly associated with a 16% lower rate of hospital visits (adjusted incidence rate ratio 0.84, 95% CI 0.72-0.98, P = 0.036). Poorer adherence using both measures was associated with higher GP visits. Improvements in BIC favoured models using PDC. CONCLUSIONS: Medication refill-adherence, measured using PDC in community pharmacy settings, could be used to recognise poor antihypertensive adherence to enable effective targeting of clinical interventions to improve hypertension management and outcomes.
No takes yet. Share an insight, caveat, or question.
Dillon et al. (2019) conducted a cohort in Hypertension (n=905). Antihypertensive medication adherence evaluated by proportion of days covered (PDC) and group-based trajectory modelling (GBTM) was evaluated on Number of hospital visits and general practitioner (GP) visits (adjusted incidence rate ratio 0.84, 95% CI 0.72-0.98, p=0.036). Each 10% increase in antihypertensive refill-adherence measured by proportion of days covered was associated with a 16% lower rate of hospital visits (adjusted IRR 0.84; 95% CI 0.72-0.98; P=0.036).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: