Antihypertensive Drug Medication Adherence of People with Disabilities and its Affecting Factors in Korea

고혈압약 투약을 시작한 장애인의 투약 순응도와 이에 영향을 미치는 요인

  • Published : 2007.05.31

Abstract

Objectives : The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. Methods : The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. Results : The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence $(CMA{\geq}80%)$ rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. Conclusions : The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.

Keywords

References

  1. 보건복지부. 2001년 국민건강영양조사. 보건복지부; 2002, 93-96
  2. The sixth report of the joint national committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(24): 2413-2446 https://doi.org/10.1001/archinte.157.21.2413
  3. Kaplan NM. Clinical Hypertension. 7th ed. Pennsylvania: Williams & Wilkins; 1998. p.133-158
  4. Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J. Predictors of uncontrolled hypertension in ambulatory patients. Hypertension 2001; 38(4): 809-814 https://doi.org/10.1161/hy0901.091681
  5. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med 1984; 100(2): 258-268 https://doi.org/10.7326/0003-4819-100-2-258
  6. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: A meta-analysis. Med Care 2002; 40(9): 794-811 https://doi.org/10.1097/00005650-200209000-00009
  7. Soumerai SB, Ross DD, Avorn J, McLaughlin T, Choodnovskiy I, Effects of medicaid drug- payment limits on admission to hospitals and nursing homes. N Engl J Med 1991; 325(15): 1072-1077 https://doi.org/10.1056/NEJM199110103251505
  8. Lawthers AG, Pransky GS, Peterson LE, Himmelstein JH. Rethinking quality in the context of persons with disability. Int J Qual Health Care 2003; 15(4): 274-299
  9. Dejong G. An overview of the problem: primary care for persons with disabilities supplement: Introduction. Am J Phys Med Rehabil 1997; 76(3): S2-S8
  10. Dejong G, Plasbo SE, Beatty PW, Jones GC, Kroll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q 2002; 80(2): 261-301 https://doi.org/10.1111/1468-0009.t01-1-00004
  11. Sutton JP, Dejong G. Managed care and people with disabilities: Framing the issues. Arch Phys Med Rehabil 1998; 79(10): 1312- 1316 https://doi.org/10.1016/S0003-9993(98)90283-0
  12. Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilton SA. Access to health care services among people with chronic or disabling conditions: Patterns and predictors. Arch Phys Med Rehabil 2003; 84(10): 1417- 1425 https://doi.org/10.1016/S0003-9993(03)00268-5
  13. Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Rep 2004; 119(4): 418-426 https://doi.org/10.1016/j.phr.2004.05.006
  14. Park JH, Lee JS, Lee JY, Hong JY, Kim SY, Kim SO, Cho BH, Kim YI, Shin Y, Kim Y. Factors affecting National Health Insurance mass screening participation in the disabled. J Prev Med Public Health 2006; 39(6): 511-519 (Korean)
  15. Eun SJ, Hong JY, Lee JY, Lee JS, Kim Y, Kim YI, Shin Y. Differences in medical care utilization rates of disabled and the non- disabled with ambulatory care sensitive conditions. J Prev Med Public Health 2006; 39(5): 411-418 (Korean)
  16. Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: Methods, validity, and applications. J Clin Epidemiol 1997; 50(1): 105-116 https://doi.org/10.1016/S0895-4356(96)00268-5
  17. Steiner JF, Fihn SD, Blair B, Inui TS. Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol 1991; 44(12): 1361-1371 https://doi.org/10.1016/0895-4356(91)90097-S
  18. Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice. CMAJ 1999; 160(1): 31-37
  19. Marentette MA, Gerth WC, Billings DK, Zarnke KB. Antihypertensive persistence and drug class. Can J Cardiol 2002; 18(6): 649-656
  20. Cramer J, Rosenheck R, Kirk G, Krol W, Krystal J. Medication compliance feedback and monitoring in a clinical trial: Predictors and outcomes. Value Health 2003; 6(5): 566-573 https://doi.org/10.1046/j.1524-4733.2003.65269.x
  21. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: Clinical applications. JAMA 2002; 288(22): 2880-2883 https://doi.org/10.1001/jama.288.22.2880
  22. Grant RW, Singer DE, Meigs JB. Medication adherence before an increase in antihy- pertensive therapy: A cohort study using pharmacy claims data. Clin Ther 2005; 27(6): 773-781 https://doi.org/10.1016/j.clinthera.2005.06.004
  23. McComhs JS, Nichol MB, Newman CM, Sclar DA. The costs of interrupting antihy-pertensive drug therapy in a medical population. Med Care 1994; 32(3): 214-226 https://doi.org/10.1097/00005650-199403000-00003
  24. Park JH. Antihypertensive drug medication adherence of National Health Insurance beneficiaries and its affecting factors in Korea [dissertation]. Korea: Seoul Univ; 2006
  25. Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW. The association of antidepre- ssant medication adherence with employee disability absences. Am J Manag Care 2007; 13(2): 105-112
  26. Ebert DA, Heckerling PS. Communication disabilities among medical inpatients. N Engl J Med 1998; 339(4): 272-273 https://doi.org/10.1056/NEJM199807233390415
  27. Lennox N, Chaplin R. The psychiatric care of people with intellectual disabilities: The perceptions of trainee psychiatrists and psychiatric medical officers. Aust NZ J Psychiatry 1995; 29(4): 632-637 https://doi.org/10.3109/00048679509064978
  28. Lee SW, Kam S, Chun BY, Yeh MH, Kang YS, Kim KY, Lee YS, Park KS, Son JH, Oh HS, Ahn MY, Lim PD. Therapeutic compliance and its related factors of patients with hypertension in rural area. J Prev Med Public Health 2000; 33(2): 215-225 (Korean)
  29. 김윤, 이진용, 이범석, 김완호, 이진석, 문남주, 이광선, 안중호, 심현섭, 박종연, 김성옥, 이지전, 이정은. 장애인의 요양급여 이용실태 분석 및 의료보장 강화방안 연구. 국민건강보험공단; 2005, 205-284
  30. Lee JY. Development and application of medical health needs assessment tools for the disabled [dissertation]. Korea: Seoul Univ; 2006
  31. Ahn JH, Lee JY, Kim Y, Kim YI, Shim HJ, Lee KS. Analysis of necessity and adequa- teness of hearing rehabilitations in hearing impaired persons. Korean J Otolaryngol - Head Neck Surg 2007; 50(3): 198-202
  32. Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility impairments and use of screening and preventive services. Am J Public Health 2000; 90(6): 955-961 https://doi.org/10.2105/AJPH.90.6.955
  33. Grymonpre R, Cheang M, Fraser M, Metge C, Sitar DS. Validity of a prescription claims database to estimate medication adherence in older persons. Med Care 2006; 44(5): 471-477 https://doi.org/10.1097/01.mlr.0000207817.32496.cb
  34. Wandless I, Mucklow JC, Smith A, Prudham D. Compliance with prescribed medicines: A study of elderly patients in the community. J Royal Coll Gen Prac 1979; 29(204): 391-396
  35. Choo PW, Rand CS, Inui TS, Lee ML, Cain E, Cordeiro-Breault M, Canning C, Platt R. Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Med Care 1999; 37(9): 846-857 https://doi.org/10.1097/00005650-199909000-00002
  36. Cramer JA, Mattson RH, Prevey ML, Schcyer RD, Ouellctte VL. How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261(22): 3273-3277 https://doi.org/10.1001/jama.261.22.3273
  37. Haynes RB, Taylor DW, Sackett DL. Compliance in Health Care. 1st ed. Baltimore: Johns Hopkins University Press; 1979. p. 174- 192