Study: CVS Caremark researchers explore demographic factors on medication adherence
WOONSOCKET, R.I. — A study conducted by researchers at CVS Caremark and Brigham and Women’s Hospital and published in the May issue of the American Heart Journal found that non-white patients had 50% greater odds of statin medication nonadherence compared with white patients, while women had 10% greater odds of statin nonadherence compared with men.
The researchers noted that there are a number of potential reasons for nonadherence among women and non-white patients. For example, active prevention of cardiovascular disease may not be a priority for women and their healthcare providers because of the common misconception that women are less at risk than men. In addition, women also frequently serve as informal caregivers for family members and may be further impacted by the fact that caregivers frequently have lower rates of medication adherence.
The reasons that non-white patients may be nonadherent may be more complex. As an example, the researchers noted that non-white patients are less likely to have a consistent relationship with a primary care provider than white patients which can impact chronic care and adherence. Additionally, both women and various racial and ethnic minorities may be more likely to experience side effects from statins, a commonly cited reason for early discontinuation or poor adherence.
"These findings help us better understand the impact of certain demographic factors on medication adherence," stated Niteesh Choudhry, associate physician, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and associate professor, Harvard Medical School. "Since a large number of patients depend on medication therapy for primary and secondary prevention of cardiovascular disease, we believe that efforts to reduce nonadherence for statins can have a significant effect on addressing health care disparities, improving health outcomes and ultimately reducing costs."
The study consisted of a literature review of more than 50 publications focused on gender and racial disparities associated with medication adherence and included more than 1.7 million patients. Of note, the finding that nonadherence was higher based on the patient’s gender or race held true even in those studies that adjusted for income, insurance status, co-payment amounts and other clinically important factors that could contribute to nonadherence.
"While it has long been known that sociodemographic characteristics are associated with nonadherence, this study is the first of its kind to look at the scale and scope of this association," commented Troy Brennan, EVP and chief medical officer of CVS Caremark. "This research helps those of us in the healthcare field better understand how to improve our outreach to patients who may be at a higher risk of non-adherence and develop programs to help these patients improve their medication adherence."
CVS Caremark has been working in a multi-year collaboration with Brigham and Women’s Hospital to research pharmacy claims data in order to better understand patient behavior, particularly around medication adherence. Annual excess healthcare costs due to medication nonadherence in the U.S. have been estimated to be as much as $290 billion annually.
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Non-adherence affects everyone, however, as shown by this study and others, it seems to apply more to certain groups over others. Medication non-adherence is largely a psychological issue, due to negative associations with medication and a lack of motivation. While this study found that non-whites and women had higher non-adherence, HealthPrize recently conducted a survey and found adults aged 18-34 struggled the most with adherence. 60% of this group admitted to not taking their medication as prescribed over the past year, which was double the rate of adults 65 years old and older.To find out why, read more here: http://bit.ly/194OyYo. -Dr. Katrina Firlik
Almost half of all adults expect to get a flu shot next year
NEW YORK — A Harris Interactive poll released Tuesday found that 44% of all adults reported getting their flu shot this past season, the second time flu shot penetration has reached that high in four years, and even more are expected to get a flu shot next season. Almost half of consumers had reported getting the flu shot in the previous season in April 2011. The number of people claiming they’ve gotten a flu shot has remained at or around 40% since 2009, conceivably a fall-out from the 2009 H1N1, or "swine flu," virus.
In comparison, only 27% of people reported getting inoculated in March of 2005.
And as many as 14% of adults believed they had the flu last winter. That metric has remained below 14% for the past three years (11% reported having the flu in 2011 and 2012, and 12% in 2010). Prior to that, almost 1-in-5 people reported having got the flu most years.
Because flu symptoms are sometimes confused with symptoms of other conditions, people who said they had had the flu were asked if they had visited a doctor who had diagnosed flu. Only 35% of those had flu shots and who also believe that they had the flu report that their flu was diagnosed by a doctor, a big drop from a high of between 55% and 60% across the two previous winters.
For the upcoming 2013/2014 season, 47% of all adults suggested they would be getting a flu shot, compared to 40% who reported they would not get a flu shot and 13% who were unsure. Of those who had a flu shot for the 2012/2013 season, 90% plan to repeat this upcoming season. Of those who had not had a flu shot last year, 12% plan to get one this year.
More than 9-in-10 adults reported getting a flu shot and subsequently not getting the flu. Of those who did not get a flu shot this past season, only 9% reported not getting the flu (73% reported getting the flu and 18% weren’t sure).
"There are two reasons to be careful when analyzing these data," noted Harris poll chairman Humphrey Taylor. "One is that the diagnosis, and particularly self-diagnosis, of the flu is not very reliable. Other infections can produce flu-like symptoms." This year’s survey, similar to last year’s survey, finds that about three fifths of these people are "certain" they had the flu (61%) and spent one or more days in bed (62%).
"[And] the absence of a direct correlation between those who had flu shots and those who did not get the flu does not mean that the flu shots had no effect, because those who are more likely to get the flu may also be more likely to get flu shots," Taylor added.
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Temporary stay of Plan B decision extended through May 28
NEW YORK — The Food and Drug Administration’s temporary stay pending its appeal of a district court decision ordering all levonorgestrel-based emergency contraceptives be available without a prescription and without any age restrictions was extended through May 28 by the U.S. Court of Appeals for the Second Circuit on Monday.
The Second Circuit will entertain the appeal on that day.
"Although the district court rejected the government’s position in the strongest terms, the court plainly exceeded its jurisdiction in ordering FDA to take any action on the one-pill drug and to make any of these drugs available without a prescription or any other restriction without conducting a rulemaking," the appeal reads. "Because the district court plainly overstepped its authority, there is a substantial likelihood that the government will prevail in this appeal. The balance of harms and the public interest also strongly support a stay."
Senior United States District Judge Edward Korman on Friday had denied an FDA motion for a stay pending an appeal of Korman’s earlier decision that all levonorgestrel-based emergency contraceptives be available without a prescription and without any age restrictions.
However, Korman had granted a stay "pending the hearing or submission of the defendants’ motion for a stay in the Court of Appeals on the condition that the motion for a stay be filed by noon on May 13, 2013." It was a deadline that the FDA honored.
In a 17-page decision, Korman noted he was not appeased by FDA’s decision regarding Plan B One-Step. "Plan B One-Step aside, the effect of my [original] decision was to make levonorgestrel-based emergency contraceptives available without a prescription and without any point-of-sale or age restrictions," he wrote. "The only practical difference between my decision and the decision of the FDA that the Secretary reversed was that the FDA’s decision was arguably directed towards the one-pill version of the drug, and my decision applied to both versions."
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