Environmental and individual predictors of medication adherence among elderly patients with hypertension and chronic kidney disease: A geospatial approach.
Chronic kidney disease (CKD)
Environment
Geospatial analysis
Hypertension
Medication adherence
Journal
Research in social & administrative pharmacy : RSAP
ISSN: 1934-8150
Titre abrégé: Res Social Adm Pharm
Pays: United States
ID NLM: 101231974
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
12
01
2019
revised:
19
06
2019
accepted:
19
06
2019
pubmed:
30
6
2019
medline:
29
7
2021
entrez:
30
6
2019
Statut:
ppublish
Résumé
Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals' medication-taking behaviors in patients. To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States. The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence. A total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence. Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.
Sections du résumé
BACKGROUND
Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals' medication-taking behaviors in patients.
OBJECTIVE
To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States.
METHODS
The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence.
RESULTS
A total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence.
CONCLUSIONS
Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.
Identifiants
pubmed: 31253498
pii: S1551-7411(19)30019-1
doi: 10.1016/j.sapharm.2019.06.011
pmc: PMC6925652
mid: NIHMS1532878
pii:
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
422-430Subventions
Organisme : NLM NIH HHS
ID : HHSN276201400001C
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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