Only 63% of New Yorkers on Medicaid with chronic conditions are adherent to drug regimens

A new study published online this month in the Journal of Urban Health conducted by researchers in the Department of Population Health at NYU Langone Medical Center, the New York City Department of Health and Mental Hygiene, and the New York State Department of Health found only 63 percent of New Yorkers on Medicaid with chronic conditions including hypertension, diabetes and high cholesterol are adherent to medication regimens. Non-adherence to medications is associated with higher costs of care, increased hospitalizations and even death.

The study was designed to determine rates of adherence among participants enrolled in New York City Medicaid with chronic conditions most at risk for cardiovascular disease. The retrospective analysis included more than 150,000 Medicaid patients aged 20 to 64 years old and showed older patients and white patients had the greatest adherence. Black patients and Hispanic patients had the lowest adherence rates, according to the study, while adherence among Asians was similar to whites.

"The outcome of this study is concerning as it shows a large number of people with chronic conditions that lead to cardiovascular disease aren't taking prescribed medications, which could prevent a potential stroke or heart attack," said lead author Kelly Kyanko, MD, MHS, an instructor in the Department of Population Health and principal investigator of the study. "We hope these findings will help local health authorities in the New York City area address this problem by creating programs to increase adherence rates, specifically in patient populations most at risk."

Cardiovascular disease is the leading cause of death in the United States and in New York State. Having chronic conditions like hypertension, diabetes and high cholesterol can cause cardiovascular disease if left untreated, which can lead to atherosclerosis and major cardiovascular events, including heart attack and stroke. A quarter of New Yorkers have high blood pressure and 12 percent of the city's population has diabetes. "Many people do not even know they have these diseases," Kyanko said.

The study was performed using the 2008-2009 New York State Department of Health's Medicaid claims database of New York City residents. Those included in the study were continually enrolled in Medicaid for 15 months and suffered from hypertension, diabetes and/or high cholesterol and filled at least one prescription for a chronic condition since they enrolled in the program.

"We believe that patients and their doctors can work to improve medication adherence through simple measures such as switching to once-a-day or combination pills, keeping a pill box, and obtaining 90 day refills instead of 30 day refills for medications they take on a regular basis," said Dr. Kyanko. She noted that for high risk patients, more intensive interventions such as working with a nurse or pharmacist may be needed to ensure adherence.