Health systems must be more ‘adherence-friendly’

By Piriya Mahendra, medwireNews Reporter

Heath system strategies must be appropriately designed to help narrow persistent racial/ethnic gaps in the use of antihypertensive therapy, say researchers.

Alyce Adams (Kaiser Permanente, Oakland, California, USA) and team say that strategies designed to reduce patient copayments, ease access to medications, and optimize the choice of initial therapy should be adopted to minimize racial/ethnic differences in medication-taking behavior.

In a hypertension registry of 44,167 adults aged 18 or over who were new users of antihypertensive therapy in 2008, more than 30% were early nonpersistent (defined as failing to refill prescription within 90 days of first prescription date).

One in five new users were nonadherent to therapy, which was defined as not having medication available for 20% or more of days during 12 months following initiation of therapy.

Analysis showed that non-White individuals were more likely to exhibit both these types of suboptimal medication-taking behaviors compared with White individuals.

Logistic regression analysis adjusted for sociodemographic, clinical, and health system factors showed that non-White race was independently linked to early nonpersistence, at respective odds ratios (ORs) of 1.56, 1.40, and 1.46 for Black, Asian, and Hispanic individuals.

As reported in the Archives of Internal Medicine, non-White race was also associated with nonadherence, at respective ORs of 1.55, 1.13, and 1.46 for Black, Asian, and Hispanic individuals.

The likelihood for early nonpersistence varied between Asians and Hispanics by choice of first-line therapy, note the researchers. In addition, racial and ethnic differences in nonadherence were appreciably attenuated when medication copayment and mail-order pharmacy use were accounted for in the models.

The authors explain that unlike socioeconomic and psychosocial determinants that can be difficult to change, medication choice, copayment, and access can be modified through system-level intervention and "have the potential to reduce nonadherence, a well-known and especially challenging aspect of hypertension management in high-risk populations."

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