PCV83 FACTORS AFFECTING ADHERENCE TO ANTIHYPERTENSIVE MEDICATION IN A NIGERIAN POPULATION

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PCV83 FACTORS AFFECTING ADHERENCE TO ANTIHYPERTENSIVE MEDICATION IN A NIGERIAN POPULATION
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  A156  Abstracts 405 citations. Two reviewers independently examined each citation and abstract. Weconducted three levels of review resulting in 94 papers for full review. Data wereanalyzed using qualitative and quantitative methods, including a meta-analysis using a random effects model (REM) and Mantel-Haenszel (MH) summary estimate. RESULTS: The most common research design involved randomized controlled trials(RCTs) (60/94, 64%). Seventy-two (77%) studies involved interventions that soughtto directly improve medication compliance, 12 (13%) had to do with interventions toimprove compiance troug a mutiiscipinary process, 5 (5%) invove interven-tions to indirectly improve compliance through changing physician practice, and 5 (5%) were other types. Thirteen studies (14%) involved the use of a theoretical framework to guide the research. A meta-analysis was conducted of RCTs of educa-tional interventions, (N 6). The REM showed a trend toward statistical significancewith a risk ratio of 0.83 for non-compliance (95% CI: 0.68   1.00, p 0.05). TheMH summary estimate was statistically significant with a risk ratio of 0.83 for non-compliance (95% CI: 0.75–0.92, p  0.00), favoring patients who received educational interventions to improve compliance. However, the X2 test for heterogeneity was sig-nificant; p  0.020 and p   0.016 respectively. ONCLUSIONS: Our analysis indi-cated that most interventions focused on directly improving medication compliance. The meta-analysis illustrated educational strategies provide a significant benefit in reducing non-compliance in patients using antihypertensives. The small sample size may have contributed to the observed heterogeneity and require additional investiga-tion. Our findings have implications for designing future research and implementing educational interventions. PCV80MEDICATION ADHERENCE AND CARDIOVASCULAR DISEASE-RELATEDHEALTH CARE RESOURCE UTILIZATION AMONG PATIENTS TREATED WITH FIXED DOSE COMBINATION VERSUS MULTI-PILL COMBINATION THERAPIES AMONG PATIENTS WITH DYSLIPIDEMIA IN A MANAGED CARE POPULATION Balu S 1 , Simko RJ, Webb SF 1 , Quimbo R 2 , Cziraky MJ 2 1 Abbott Laboratories, Abbott Park, IL, USA, 2 HealthCore, Inc., Wilmington, DE, USA OBJECTIVES: Evaluate the impact of medication adherence on total health careresource utilization (THR) among dyslipidemia patients initiating fixed dose combina-tion (FDC) therapy versus multi-pill combination (MPC) therapies in a managed carepopulation. METHODS:  Using claims data from the HealthCore Integrated Research Dataase, stuy patients 18 years were ienti e as newy-initiating on FDC [Advicor: niacin extended release (NER)    lovastatin] or MPC’s [simvastatin   NER(NER/S), lovastatin NER (NER/L)] between January 1, 2000-June 30, 2006 [index date], with a minimum 6 months pre- and 12 months post-index health plan eligibility. Adherence was measured using medication possession ratio (MPR). Multivariate negative binomial regression was used to estimate association between study cohorts and one-year post-index cardiovascular disease (CVD)-related THR (sum of emer-gency room, inpatient, and outpatient visits) after controlling for differences in base-line age, gender, THR, Deyo-Charlson comorbidity index (DCI) score, number of non-dyslipidemia medications, and post-index adherence. RESULTS:  Among study patients [8988 patients (6638 FDC; 1687 NER/S; 663 NER/L)], those initiating FDC therapy were significantly younger [mean (SD) ages of 51.9 (10.5) vs. 56.0 (9.8) years,p 0.0001], comprised of fewer males (73.0% vs. 81.5%; p 0.0001), and had sig-nificantly lower baseline DCI scores (0.43 0.88 vs. 0.59 1.06; p 0.0001) versusMPC patients. During one-year follow-up, average MPR was higher among FDCpatients versus both NER/S and NER/L patients (0.54   0.35 vs. 0.50   0.35 and 0.47   0.34, respectively; p    0.01). Controlling for post-index adherence, multivariateregression demonstrated that FDC patients had an 18% decrease in annual CVD-related THR versus MPC patients [IRR: 0.819, 95% CI: 0.761–0.882); p 0.0001]. CONCLUSIONS: FDC-initiated patients showed improved medication adherence andreduced CVD-related THR versus MPC-initiated patients in this managed care popula-tion. Further studies on clinical and economic impact of improved adherence to FDCdyslipidemia therapy are warranted. PCV81MEASURING THE IMPACT OF SOCIO-DEMOGRAPHICCHARACTERISTICS ON PATIENT PERSISTENCE IN CHRONIC MARKETS Henderson SC 1  Denarie MF 2  Yuan Y 1 1 IMS Health, Blue Bell, PA, USA, 2 IMS Health, Plymouth Meeting, PA, USA OBJEC IVES: Although patient finances are widely studied as predictors of adherence,claims databases rarely include variables other than copay and insurance coverage.Linking personal income, level of education, and ethnicity to prescription data canenhance analyses of socioeconomic factors and adherence. We compared persistence in chronic markets – statins and oral antidiabetics (OADs) – by income, education, and ethnicity in linked administrative databases. METHODS: Using IMS’ LifeLink longitudinal prescription database (LRx), linked to commercial socio-economic data, we selected 143,370 patients initiating statins and 57,079 patients initiating OADs after a minimum 12 month clean period. LRx captures 62% of prescription claimscontributed by retail pharmacies in the US. Cox proportional hazards models comparedpersistence by income, education, ethnicity, age, and method of payment. RESULTS: Mean days of statin persistence was higher for patients with household income  $75K/yr (149 days) than for patients with $40–75,000K/year household income(144 days) (p   0.001). Patients with very low income (  $K/yr) were more frequently on Medicaid or over age 65; these very low income patients had higher persistence(150 days) than patients with income of $15  $40,000/year (144 days) (p 0.005). Persistence also increased with level of education (graduate school   154 days vs. high chool 147 days, p 0.001) and differed by ethnicity (Caucasian 150 days, Hispanic   127 days, African American   124 days; p  0.001). Similar trends were observed with OADs. CONCLUSIONS: Patients with higher household income demonstrate slightly improved persistence, while patients with very low income, but subsidized pharmacy benefits, also have higher than average persistence. Differences in persistence lso are found with higher levels of education and across ethnic groups. PCV82FRACTION OF NURSING HOME ADMISSION AND INCREMENTAL COSTATTRIBUTABLE TO NON ADHERENCE TO ANTI HYPERTENSIVE MEDICATIONS Rapp T Schneider M, Zuckerman IH University of Maryland, Baltimore, MD, USA OBJECTIVES:  We estimated the relationship between nursing home admission and non-adherence to anti-hypertensive medications. We calculated the incremental proportion of nursing home admission that was due to non-adherence, and theannual incremental cost of the proportion of nursing home admission due to non-adherence.  ME HODS:  We calculated adherence scores in a cohort of 225,624 sub-jects with hypertension from the MarketScan database. We used a generalized linear model with a binomial distribution and a log link to estimate adjusted relative risksof nursing home admission. We calculated the fraction of nursing home admissionttributable to non-adherence.  RESULTS: We showed that non-adherence to anti-hypertensive medications increases the risk of nursing home admission. Among non-adherent subjects, 10.8% were admitted to nursing homes. In the general populationo community-weing eery sujects, 1.9% o nursing ome amissions were attributable to non-adherence to anti-hypertensive medication. Extending these resultsto the United States elderly (age  65) population with hypertension, we found that annually 28,372 subjects were admitted to nursing homes in 2002 because of non-adherence to anti-hypertensive medications. In 2002, the cost of nursing home admis-ion due to non-adherence was estimated to be $1.7 billion. ONCLUSIONS: Anti-hypertensive medication non-adherence was a risk factor for elderly transitioningto long-term care facilities. Since non-adherence may be viewed as a proxy for lack of social support, our results show the potential benefits related to interventions thatcould provide social support to elderly patients, such as assistance with medication dministration. PCV83FACTORS AFFECTING ADHERENCE TO ANTIHYPERTENSIVEMEDICATION IN A NIGERIAN POPULATION Ekwunife OI 1 , Aguwa CN 1 , Udeogaranya PO 2 1 University of Nigeria Nsukka, Nsukka, Enugu State, Nigeria, 2 University of Nigeria Nsukka, Nsukka, Enugu, Nigeria OBJECTIVES:  Poor adherence to anti-hypertensives severely compromises the effec-tiveness of treatment. The aim of this study was to measure adherence to antihyper-tensive therapy and to determine the factors that are associated with poor adherencein a sample of hypertensive patients in Nsukka, a semi urban town located in South-Eastern Nigeria.  ME HODS:  A cross sectional, household survey was conducted inNsukka. Adherence to antihypertensive medications was assessed on participants thatwere hypertensive. Patient self-reports about the number of pills taken over a pre-scribed period were used to estimate adherence as a percentage. In addition, Morisky Medication Adherence Scale (MMAS) was used in order to increase the strength and consistency of patient’s self-report on adherence.  RESULTS: A total of 756 partici-pants were screened for hypertension. Forty-seven persons were hypertensive. Mean adherence to hypertension medication was 70.7%   37.9%. Mean adherence score was correlated to MMAS score (r 0.401, p 0.05). Educational status, making medications a habit, and experience of side effects were independently correlated toadherence. Multiple linear regression showed that for every increase in educational status, adherence increased by 12.1%. Also making medication a habit increased adherence by 35.09%. However, experience of side-effect decreased adherence by20.1%.  CONCLUSIONS: These factors identified as correlates of adherence to anti-hypertensives in the study population could be used to design interventions to improve dherence to hypertension medications in Nigeria. PCV86FLUSHING ASSESSMENT TOOL (FAST): PSYCHOMETRIC PROPERTIESF A NEW MEASURE ASSESSING FLUSHING SYMPTOMS Kawata AK 1 , Thakkar R 2 , Davidson MH, Punzi HA 4  Jiang P 2 , Li D 2 , Krause S 2 , Padley R 2  Revicki DA 1 1 United BioSource Corporation, Bethesda, MD, USA, 2 Abbott Laboratories, Abbott Park, IL, USA, 3 University of Chicago, Chicago, IL, USA, 4 Punzi Medical Center and Trinity Hypertension Research Institute, Carrollton, TX, USA OBJEC IVES:  A common side effect of niacin therapy is flushing characterized by warmth, redness, itching, and/or tingling. The FAST was developed to assess flushing symptoms and clinical impact on patients. This study evaluated the psychometrics andminimal important difference (MID) of the FAST. METHODS: A randomized, double-lind, parallel group, multicenter, placebo (PBO)-controlled prospective 6-week study evaluated the FAST. 269 patients with dyslipidemia were randomized (1:1:1) to niacin extended-release (NER)/acetylsalicylic acid (ASA), NER/ASA PBO, or PBO/PBO. Patients completed the FAST electronic diary daily. RESUL S:  FAST test-retest reli-ability during the first 2 weeks among stable subjects was demonstrated for meanoverall flushing severity using patient/physician-rated overall treatment effect (OTE) ratings (intraclass correlation coefficients of 0.75 and 0.76). Over the 6 week treatment
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