Objectives: This research identified the potential predictors of medication adherence and studied the impact of medication adherence on healthcare utilization and costs among elderly with diabetes who were enrolled in a State Pharmaceutical Assistance Program (SPAP).
Methods: Pharmaceutical Assistance Contract for Elderly (PACE) programs’ database was used to identify study population and estimate medication adherence as proportion of days covered (PDC) for 12-months post-index observation period (adherent: PDC ≥ 80%; nonadherent: PDC < 80%). Healthcare utilization and costs for the study period were estimated using Pennsylvania Health Care Cost Containment Council’s hospital inpatient discharge records. Healthcare utilization measures included all-cause, diabetes-specific, diabetes-related and diabetes-specific & related number of inpatient hospital admissions and length of stay (LOS). Multiple regression analyzes were performed to determine the predictors of medication adherence and to assess the association of medication adherence with risk of hospitalization, hospital service utilization and costs.
Results: Among 9,497 elderly PACE enrollees with diabetes, 81% were adherent and 21% were hospitalized. Race, marital status, number of unique medications and out-of-pocket payment were the significant predictors of medication adherence. The odds of being hospitalized were higher for nonadherent patients by the factor 2.030 than adherent patients (95% CI: 1.784–2.310). After controlling for covariates, non-adherent patients had significantly a greater number of all-cause (IRR 1.2727; 95% CI 1.1937–1.3569), more diabetes-related (IRR 1.2210; 95% CI 1.0492–1.4210) and more combined diabetes-specific & related (IRR 1.2106; 95% CI 1.0495–1.3965) hospital visits than adherent patients. After adjusting for covariates, LOS for non-adherent patients was longer for all-cause (IRR 1.2388; 95% CI 1.1706–1.3111), diabetes-related (IRR 1.1341; 95% CI 1.0415–1.2349) and for diabetes-specific & related (IRR 1.1271; 95% CI 1.0357–1.2267) hospitalization than adherent patients. GLM models showed that medication nonadherence was associated with significant increase in all-cause hospitalization costs ($22,670 vs $16,383; p < 0.0001) and diabetes-related hospitalization costs ($13,518 vs $12,634; p = 0.0003).
Conclusions: Medication nonadherence was associated with an increased risk of hospitalization, greater number of hospital visits, longer hospital LOS and substantial hospitalization costs among elderly SPAP beneficiaries with diabetes. Utilization of our findings to develop interventions or policies to improve medication adherence would significantly impact the US healthcare system particularly while allocating limited healthcare resources.
|Commitee:||Borah, Bijan, Heller, Debra, Patterson, Brandon|
|School:||University of the Sciences in Philadelphia|
|School Location:||United States -- Pennsylvania|
|Source:||DAI-B 80/08(E), Dissertation Abstracts International|
|Subjects:||Economics, Public health, Health care management|
|Keywords:||Cost, Diabetes, Elderly, Healthcare, Medication adherence, Utilization|
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