Advertisement

Association between adherence to antihypertensive medications and health outcomes in middle and older aged community dwelling adults; results from the Irish longitudinal study on ageing

  • Caroline A. WalshEmail author
  • Caitriona Cahir
  • Kathleen E. Bennett
Pharmacoepidemiology and Prescription

Abstract

Purpose

To examine the association between antihypertensive medication (AHTM) implementation adherence and healthcare utilisation in community-dwelling adults aged ≥ 50 years in Ireland.

Methods

This was a prospective cohort study. The Irish Longitudinal Study on Ageing (TILDA) was linked to pharmacy claims data for participants aged ≥ 50 years. Participants were included if they had ≥ 3 pharmacy claims for one or more AHTM (ATC codes ‘C02’, ‘C03’, ‘C07’, ‘C08’ or ‘C09’) within the year preceding the year of self-reported healthcare utilisation outcome occurrence. Outcomes included self-reported general practitioner (GP), emergency department (ED), outpatient department visits and hospital admissions. Implementation adherence was measured using proportion of days covered (PDC), with participants classified as adherent if the average PDC ≥ 0.8. Negative binomial models were used to analyse the association between AHTM adherence and number of GP, ED, outpatient visits and hospitalisations (adjusted IRR and 95% CI are presented).

Results

One thousand four hundred thirty-one participants were included. The majority of participants (72.6%) were considered adherent. Good implementation adherence to AHTM was associated with a significant decrease in self-reported GP visits (adjusted IRR 0.91, 95% CI 0.83–0.99). Adherence had no significant impact on the number of ED visits, outpatient visits or hospitalisations reported by TILDA participants.

Conclusions

Good adherence to AHTM was associated with less self-reported GP visits in this population, suggesting improved overall health status. However, the impact of medication non-adherence on the other self-reported healthcare utilisation outcomes (ED, outpatient visits and hospitalisations) was not evident in this study.

Keywords

Medication adherence Hospitalisation Health outcomes Older 

Notes

Acknowledgements

The authors wish to thank TILDA staff at Trinity College Dublin and staff at the HSE-PCRS for collecting and providing the authors with the data used in this study.

Authors’ individual contributions

CW, CC and KB were involved in the concept and design of the study. Data was provided by TILDA and the HSE-PCRS. CW carried out the statistical analysis. All authors were involved in interpretation of the data. CW wrote the first draft of the manuscript and all authors contributed to subsequent drafts.

Funding

CW, CC and KB were funded by the Health Research Board (HRB), Research Leaders Award (HRB RL-2015-1579). This work was conducted as part of the SPHeRE Programme under Grant No. SPHeRE/2013/1. TILDA is supported by the Department of Health and Children, The Atlantic Philanthropies and Irish Life.

Compliance with ethical standards

Ethical approval

Ethical approval for each wave of TILDA was obtained from the Trinity College Research Ethics Committee. Provision was made within this application to allow for the linking of participants GMS dispensing data, subject to participants’ consent.

Disclaimer

The funding bodies had no role in this study design, data analysis, writing of the manuscript or the decision to submit for publication.

Supplementary material

228_2019_2699_MOESM1_ESM.pdf (259 kb)
Supplementary Table 1 (PDF 259 kb)
228_2019_2699_MOESM2_ESM.pdf (276 kb)
Supplementary Table 2 (PDF 275 kb)
228_2019_2699_MOESM3_ESM.pdf (278 kb)
Supplementary Table 3 (PDF 278 kb)
228_2019_2699_MOESM4_ESM.pdf (276 kb)
Supplementary Table 4 (PDF 276 kb)
228_2019_2699_MOESM5_ESM.pdf (277 kb)
Supplementary Table 5 (PDF 276 kb)

References

  1. 1.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J, for the ABCPT (2012) A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 73(5):691–705.  https://doi.org/10.1111/j.1365-2125.2012.04167.x CrossRefGoogle Scholar
  2. 2.
    Vik SA, Maxwell CJ, Hogan DB (2004) Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 38(2):303–312.  https://doi.org/10.1345/aph.1D252 CrossRefGoogle Scholar
  3. 3.
    Bjerrum L, Søgaard J, Hallas J, Kragstrup J (1998) Polypharmacy: correlations with sex, age and drug regimenA prescription database study. Eur J Clin Pharmacol 54(3):197–202.  https://doi.org/10.1007/s002280050445 CrossRefGoogle Scholar
  4. 4.
    Hughes CM (2004) Medication non-adherence in the elderly: how big is the problem? Drugs Aging 21(12):793–811.  https://doi.org/10.2165/00002512-200421120-00004 CrossRefGoogle Scholar
  5. 5.
    Vik SA, Hogan DB, Patten SB, Johnson JA, Romonko-Slack L, Maxwell CJ (2006) Medication nonadherence and subsequent risk of hospitalisation and mortality among older adults. Drugs Aging 23(4):345–356.  https://doi.org/10.2165/00002512-200623040-00007 CrossRefGoogle Scholar
  6. 6.
    Gellad WF, Grenard JL, Marcum ZA (2011) A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 9(1):11–23.  https://doi.org/10.1016/j.amjopharm.2011.02.004 CrossRefGoogle Scholar
  7. 7.
    Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA (2017) Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine 96(4):e5641.  https://doi.org/10.1097/md.0000000000005641 CrossRefGoogle Scholar
  8. 8.
    Chobanian AV (2009) Impact of nonadherence to antihypertensive therapy. Circulation 120:1558–1560.  https://doi.org/10.1161/CIRCULATIONAHA.109.906164 CrossRefGoogle Scholar
  9. 9.
    Oliveira-Filho AD, Barreto-Filho JA, Neves SJ, Lyra Junior DP (2012) Association between the 8-item Morisky medication adherence scale (MMAS-8) and blood pressure control. Arq Bras Cardiol 99(1):649–658  https://doi.org/10.1590/S0066-782X2012005000053 CrossRefGoogle Scholar
  10. 10.
    Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM, for the SPRINT Research Group (2016) Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 315(24):2673–2682.  https://doi.org/10.1001/jama.2016.7050 CrossRefGoogle Scholar
  11. 11.
    Degli Esposti L, Saragoni S, Benemei S, Batacchi P, Geppetti P, Di Bari M, Marchionni N, Sturani A, Buda S, Degli Esposti E (2011) Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients. Clinicoecon Outcomes Res 3:47–54.  https://doi.org/10.2147/ceor.s15619 CrossRefGoogle Scholar
  12. 12.
    Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, Borghi C, Brignoli O, Caputi AP, Cricelli C, Mantovani LG (2009) Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 120(16):1598–1605.  https://doi.org/10.1161/circulationaha.108.830299 CrossRefGoogle Scholar
  13. 13.
    Yang Q, Chang A, Ritchey MD, Loustalot F (2017) Antihypertensive medication adherence and risk of cardiovascular disease among older adults: a population-based cohort study. J Am Heart Assoc 6(6).  https://doi.org/10.1161/jaha.117.006056
  14. 14.
    Perreault S, Yu AY, Cote R, Dragomir A, White-Guay B, Dumas S (2012) Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes. Neurology 79(20):2037–2043.  https://doi.org/10.1212/WNL.0b013e3182749e56 CrossRefGoogle Scholar
  15. 15.
    Corrao G, Rea F, Ghirardi A, Soranna D, Merlino L, Mancia G (2015) Adherence with antihypertensive drug therapy and the risk of heart failure in clinical practice. Hypertension 66(4):742–749.  https://doi.org/10.1161/hypertensionaha.115.05463 CrossRefGoogle Scholar
  16. 16.
    Kettani FZ, Dragomir A, Cote R, Roy L, Berard A, Blais L, Lalonde L, Moreau P, Perreault S (2009) Impact of a better adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke 40(1):213–220.  https://doi.org/10.1161/strokeaha.108.522193 CrossRefGoogle Scholar
  17. 17.
    Rasmussen JN, Chong A, Alter DA (2007) Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA 297(2):177–186.  https://doi.org/10.1001/jama.297.2.177 CrossRefGoogle Scholar
  18. 18.
    Tu W, Morris AB, Li J, Wu J, Young J, Brater DC, Murray MD (2005) Association between adherence measurements of metoprolol and health care utilization in older patients with heart failure. Clin Pharmacol Ther 77(3):189–201.  https://doi.org/10.1016/j.clpt.2004.10.004 CrossRefGoogle Scholar
  19. 19.
    Hope CJ, Wu J, Tu W, Young J, Murray MD (2004) Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health-Syst Pharm 61(19):2043–2049.  https://doi.org/10.1093/ajhp/61.19.2043 CrossRefGoogle Scholar
  20. 20.
    Murray M, Tu W, Wu J, Morrow D, Smith F, Brater D (2009) Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clin Pharmacol Ther 85(6):651–658.  https://doi.org/10.1038/clpt.2009.7 CrossRefGoogle Scholar
  21. 21.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497.  https://doi.org/10.1056/NEJMra050100 CrossRefGoogle Scholar
  22. 22.
    Kenny RA, Whelan BJ, Cronin H, Kamiya Y, Kearney P, O’Regan C, Ziegel M (2010) The design of the Irish longitudinal study on ageing. Lenus the Irish Health Repository. https://www.lenus.ie/bitstream/handle/10147/301640/DesignReport2010.pdf;jsessionid=90014F67AA07262980411 E22BE26C4E3889?sequence=1. Accessed 10th October 2018
  23. 23.
    Barrett A, Burke H, Cronin H, Hickey A, Kamiya Y, Kenny RA, Layte R, Maty S, McGee H, Morgan K (2011) Fifty plus in Ireland 2011: first results from the Irish Longitudinal Study on Ageing (TILDA). Lenus the Irish Health Repository . https://www.lenus.ie/handle/10147/129741. Accessed 10th October 2018
  24. 24.
    Sinnott S-J, Bennett K, Cahir C (2017) Pharmacoepidemiology resources in Ireland—an introduction to pharmacy claims data. Eur J Clin Pharmacol 73(11):1449–1455.  https://doi.org/10.1007/s00228-017-2358-4 CrossRefGoogle Scholar
  25. 25.
    De Geest S, Zullig LL, Dunbar-Jacob J, Helmy R, Hughes DA, Wilson IB, Vrijens B (2018) ESPACOMP medication adherence reporting guideline (EMERGE). Ann Intern Med 169(1):30–35.  https://doi.org/10.7326/m18-0543 CrossRefGoogle Scholar
  26. 26.
    Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC (2008) An empirical basis for standardizing adherence measures derived from administrative claims data among diabetic patients. Med Care 46(11):1125–1133.  https://doi.org/10.1097/MLR.0b013e31817924d2 CrossRefGoogle Scholar
  27. 27.
    Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15(8):565–574; discussion 575-567.  https://doi.org/10.1002/pds.1230 CrossRefGoogle Scholar
  28. 28.
    Pittman DG, Tao Z, Chen W, Stettin GD (2010) Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am J Manag Care 16(8):568–576Google Scholar
  29. 29.
    Vuong QH (1989) Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica 57(2):307–333CrossRefGoogle Scholar
  30. 30.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRefGoogle Scholar
  31. 31.
    Kim S, Shin DW, Yun JM, Hwang Y, Park SK, Ko YJ, Cho B (2016) Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hypertension 67(3):506–512.  https://doi.org/10.1161/hypertensionaha.115.06731 CrossRefGoogle Scholar
  32. 32.
    Haley WE, Gilbert ON, Riley RF, Newman JC, Roumie CL, Whittle J, Kronish IM, Tamariz L, Wiggers A, Morisky DE, Conroy MB, Kovalik E, Kressin NR, Muntner P, Goff DC (2016) The association between self-reported medication adherence scores and systolic blood pressure control: a SPRINT baseline data study. J Am Soc Hypertens 10(11):857–864.e852.  https://doi.org/10.1016/j.jash.2016.08.009 CrossRefGoogle Scholar
  33. 33.
    Little P, Somerville J, Williamson I, Warner G, Moore M, Wiles R, George S, Smith A, Peveler R (2001) Psychosocial, lifestyle, and health status variables in predicting high attendance among adults. Br J Gen Pract 51(473):987–994Google Scholar
  34. 34.
    Dillon P, Smith SM, Gallagher P, Cousins G (2019) The association between pharmacy refill-adherence metrics and healthcare utilisation: a prospective cohort study of older hypertensive adults. Int J Pharm Pract.  https://doi.org/10.1111/ijpp.12539
  35. 35.
    Prior S (2018) Budget 2019 papers: trends in general medical services (GMS). Department of Public Expenditure and Reform, Dublin. http://www.budget.gov.ie/Budgets/2019/Documents/Trends%20in%20General%20Medical%20Services%20(G454 MS)%20Scheme.pdf. Accessed on 20th December 2018
  36. 36.
    Butler RJ, Davis TK, Johnson WG, Gardner HH (2011) Effects of nonadherence with prescription drugs among older adults. Am J Manag Care 17(2):153–160Google Scholar
  37. 37.
    Kim J-A, Lim MK, Kim K, Park J, Rhee CK (2018) Adherence to inhaled medications and its effect on healthcare utilization and costs among high-grade chronic obstructive pulmonary disease patients. Clin Drug Investig 38(4):333–340.  https://doi.org/10.1007/s40261-017-0612-2 CrossRefGoogle Scholar
  38. 38.
    Modi A, Siris ES, Tang J, Sen S (2015) Cost and consequences of noncompliance with osteoporosis treatment among women initiating therapy. Curr Med Res Opin 31(4):757–765.  https://doi.org/10.1185/03007995.2015.1016605 CrossRefGoogle Scholar
  39. 39.
    Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA (2006) A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333(7557):15.  https://doi.org/10.1136/bmj.38875.675486.55 CrossRefGoogle Scholar
  40. 40.
    Ettinger AB, Manjunath R, Candrilli SD, Davis KL (2009) Prevalence and cost of nonadherence to antiepileptic drugs in elderly patients with epilepsy. Epilepsy Behav 14(2):324–329.  https://doi.org/10.1016/j.yebeh.2008.10.021 CrossRefGoogle Scholar
  41. 41.
    Grimes T, Fitzsimons M, Galvin M, Delaney T (2013) Relative accuracy and availability of an Irish National Database of dispensed medication as a source of medication history information: observational study and retrospective record analysis. J Clin Pharm Ther 38(3):219–224.  https://doi.org/10.1111/jcpt.12036 CrossRefGoogle Scholar
  42. 42.
    Wallace E, Moriarty F, McGarrigle C, Smith SM, Kenny R-A, Fahey T (2018) Self-report versus electronic medical record recorded healthcare utilisation in older community-dwelling adults: comparison of two prospective cohort studies. PLoS One 13(10):e0206201.  https://doi.org/10.1371/journal.pone.0206201 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Population Health Sciences, Beaux Lane HouseRoyal College of Surgeons in IrelandDublin 2Ireland
  2. 2.Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Centre for Health SciencesSt. James’s HospitalDublinIreland

Personalised recommendations