(Download) "Much Ado About Adherence" by Amit Sharad Kulkarni * eBook PDF Kindle ePub Free
eBook details
- Title: Much Ado About Adherence
- Author : Amit Sharad Kulkarni
- Release Date : January 18, 2013
- Genre: Medical,Books,Professional & Technical,
- Pages : * pages
- Size : 13659 KB
Description
This study assessed the impact of medication adherence on economic/health outcomes in Parkinson’s disease (PD) and insomnia in elderly patients. PD is the second most common neurodegenerative disease. Insomnia is characterized by poor quality of sleep. Depression is a comorbidity associated with PD/insomnia. This study assessed impact of demographic, clinical, and medication related factors on medication adherence (measured as regularity of refills) in elderly patients suffering from PD/insomnia. The relationship between medication adherence and patient health care utilization for PD/insomnia was also evaluated. The study also investigated the association between worsening of PD symptoms and medication adherence. The association between depressive symptomatology and medication adherence in insomnia patients was also assessed. This study used the health belief model, the Aday-Andersen health care utilization model, and the structure process outcomes model as framework for this study. This retrospective, longitudinal cohort study included older adults (65 and older) enrolled continuously for 1 to 5 years in a Medicare HMO. The study population comprised of subjects with diagnostic code for PD/insomnia and claim for at least one filled PD/insomnia prescription, respectively. Medication Possession Ratio (MPR) was used as a proxy to estimate adherence to PD/insomnia medications. Treatment guidelines were followed to develop a measure for worsening of PD symptoms. This study also assessed prevalence of non adherence to PD/insomnia medications using different thresholds of MPR (0.8,0.6,0.4,and,0.2). There was high prevalence of non adherence to PD/insomnia medications irrespective of MPR threshold chosen. An increase in MPR scores was associated with decrease in total health services utilization in PD/insomnia. Depressive symptomatology was the strongest predictor (inverse association) of medication adherence to PD/Insomnia medications. PD patients, adherent to their medications (irrespective of MPR threshold chosen) were less likely to experience worsening of PD symptoms. There was a strong negative association between depressive symptomatology and medication adherence, irrespective of MPR threshold chosen. Mass disease and risk management programs in managed care settings need to selectively target high risk patients and consider their clinical symptoms and medication management issues for optimal resource utilization and management of such ailments in these elderly patients.