Measures of adherence to oral hypoglycemic agents at the primary care clinic level: the role of risk adjustment

Medical Care
Edwin S WongChris L Bryson

Abstract

Prior research found that in the Veterans Affairs health care system (VA), the proportion of patients adherent to oral hypoglycemic agents varies from 50% to 80% across primary care clinics. This study examined whether variation in patient and facility characteristics determined those differences. Retrospective cohort study of 444,418 VA primary care patients with diabetes treated in 559 clinics in fiscal year (FY) 2006-2007. Patients' adherence to each oral hypoglycemic agent was computed for the first 3 months of FY2007, and averaged across agents to produce an adherence score for the patient's overall regimen. Patients with an adherence score over 0.8 were defined as adherent. Risk adjustment used hierarchical logistic regression accounting for patient factors and facility effects by clustering patients within clinics and clinics within parent VA medical centers. We then assessed the influence of risk adjustment using observed-to-expected (O/E) ratios computed for each clinic. The mean unadjusted proportion of adherent patients in clinics was 0.715 (interdecile range 0.559-0.826). The percent variation in patient's likelihood of being adherent explained at the patient, clinic, and parent VA medical center levels was 2.94%, 0...Continue Reading

References

Jan 1, 1997·Journal of Clinical Epidemiology·J F Steiner, A V Prochazka
Apr 1, 1997·Journal of Internal Medicine·W Insull
Jan 9, 1998·Statistics in Medicine·E R DeLongD B Mark
Jun 15, 1999·JAMA : the Journal of the American Medical Association·T P HoferW G Manning
Jul 23, 2002·JAMA : the Journal of the American Medical Association·Joshua S BennerJerry Avorn
Jul 23, 2002·Journal of General Internal Medicine·Philip S WangJerry Avorn
Jul 27, 2002·Medical Care·Matthew L MaciejewskiJohn C Fortney
Aug 3, 2002·Archives of Internal Medicine·R Graham BarrUNKNOWN National Asthma Education and Prevention Program (NAEPP)
Sep 5, 2002·International Journal of Geriatric Psychiatry·Rachel MaidmentCornelius Katona
Jan 30, 2004·Diabetes Care·John D PietteTodd H Wagner
Mar 11, 2004·Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association·M Robin DiMatteo
May 25, 2004·Diabetic Medicine : a Journal of the British Diabetic Association·R F DijkstraR P T M Grol
Nov 24, 2004·Archives of Internal Medicine·Richard W GrantJames B Meigs
May 14, 2005·The Journal of Clinical Psychiatry·David E FleckStephen M Strakowski
Jun 16, 2005·The Annals of Pharmacotherapy·Kathryn P LowryHayden B Bosworth
Dec 22, 2005·American Heart Journal·Sonali P KulkarniEric D Peterson
Mar 2, 2006·The Annals of Pharmacotherapy·Brian D De SmetDuane M Kirking
Jun 23, 2006·BMJ : British Medical Journal·Scot H SimpsonJeffrey A Johnson
Dec 14, 2006·JAMA : the Journal of the American Medical Association·Rachel M Werner, Eric T Bradlow
Jan 30, 2007·Health Affairs·Joel KupersmithJonathan B Perlin
Mar 21, 2007·Journal of General Internal Medicine·Karin M NelsonGayle Reiber
Jan 9, 2010·Medical Care·Vicki FungJoseph V Selby

❮ Previous
Next ❯

Citations

Feb 2, 2013·Journal of General Internal Medicine·Chris L BrysonChuan-Fen Liu
Sep 24, 2013·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Jaime A Davidson
Nov 15, 2012·BMC Health Services Research·Beverly Mielke KocarnikChris L Bryson
Mar 15, 2013·Patient Preference and Adherence·David F BlackburnMark Lemstra
Nov 14, 2014·BMC Health Services Research·Clarissa HsuChristopher L Bryson
May 26, 2017·Journal of Pharmacy Practice·Najwan El-SaifiHaitham Tuffaha
May 23, 2014·The Annals of Pharmacotherapy·Edwin S WongChuan-Fen Liu
May 6, 2020·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Linnaea SchuttnerJoshua M Liao

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

Related Papers

Journal of the American College of Cardiology
David F Blackburn
The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine
Nde-Eshimuni M SalemaCris Glazebrook
The Canadian Journal of Cardiology
Mark Lemstra, David F Blackburn
© 2022 Meta ULC. All rights reserved