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Poster #4
Category: Post-Doctoral Social Science/Clinical/Behavioral
PREDICTORS OF PERSISTENCE ON ANTIHYPERTENSIVE THERAPY
Fadia R. Shaya, PhD, MPH; Antoine C. El Khoury, PhD; Matthew R. Weir, MD
School of Pharmacy, Pharmaceutical Health Services Research, University of Maryland, Baltimore
Objective: To identify predictors of persistence on antihypertensive drugs in a Medicaid population.
Methods: Medical and pharmacy claims for patients on antihypertensive therapy were obtained from Maryland Medicaid for the period of 1/1/01-12/31/03. Inclusion: at least one year of follow-up. Exclusion: use of antihypertensive drugs between 1/1-6/30/01 (to obtain incident cohort) and use of fixed combinations therapy. Persistence was defined as the number of days from the index date to the date of discontinuation of therapy with an allowable gap of 15 days between refills. Race and gender specific persistence rates were adjusted for other facotrs including age, comorbidities (Charlson Comorbidity Index), and use of other drugs by applying Cox proportional hazard models.
Results: A total of 1023 patients; mean age 50, 58.75% African-American, and 39.59% male. African-Americans (HR=1.42, p<0.0001, CI 1.23-1.64) and patients with a higher comorbidity index (HR=1.06, p=0.002, CI 1.02-1.09) are more likely to discontinue their therapy than Caucasians and patients with lower comorbidity index respectivley. Males (HR=0.86, p=0.03, CI 0.76-0.98) and older patients (HR=0.99, p=0.002, CI 0.98-0.99) are more likely to be persistent than females and younger patients respectively. Drug classes and use of lipid lowering and antidiabetic drugs were not significanly associated with persistence.
Conclusion: There is significant difference in persistence rates within races and gender categories. African-Americans and women are more likely to discontinue their therapy when compared to Caucasians and men respectively. In addition, older patients and those with a lower comorbidity index are more likely to persist. Those results suggest a need for persistence educational programs targeted toward specific population. Higher antihypertensive drug persistence rates may improve cardiovascular disease management outcomes.
