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Articles   |    
Adherence to Oral Diabetes Medications Among Users and Nonusers of Antipsychotic Medication
Pooja R. Desai, M.S.; Ayoade O. Adeyemi, M.S.; Kristin M. Richards, Ph.D.; Kenneth A. Lawson, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300118
View Author and Article Information

The authors are with the College of Pharmacy, University of Texas at Austin, Austin (e-mail: poojadesai@utexas.edu).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study compared adherence to oral diabetes medications among users and nonusers of oral antipsychotic medications. Adherence to oral antidiabetics and antipsychotics among antipsychotic users was also compared.

Methods  Texas Medicaid prescription claims data from July 1, 2008, to December 31, 2011, were used to examine adherence to oral antidiabetics among users and nonusers of antipsychotics for 12 months after the first prescription for oral diabetes medication. Users and nonusers of antipsychotics were matched on the basis of their chronic disease score (CDS). Medication adherence was measured by proportion of days covered (PDC), and patients with a PDC value ≥.80 were considered to be adherent. Bivariate and multivariate analyses were used to compare adherence between cohorts.

Results  A total of 1,821 patients from each group were matched. The mean PDC for oral antidiabetics was significantly higher among antipsychotic users (.63) than nonusers (.55) (p<.001). About 37% (N=678) of antipsychotic users and 24% (N=473) of nonusers were adherent to oral antidiabetics. After adjustment for age, gender, CDS, and number of prescriptions, antipsychotic users were 2.10 times more likely than nonusers to be adherent to oral antidiabetics (p<.001). Antipsychotic users had higher mean PDC values for antipsychotic medications than for oral antidiabetics (.78±.25 versus .63±.29, p<.001).

Conclusions  Adherence to oral antidiabetics in the Texas Medicaid population was better among antipsychotic medication users than nonusers, but overall adherence was poor for both groups. Low adherence rates highlight the need for interventions to help improve medication management.

Abstract Teaser
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Table 1Characteristics of users of oral antidiabetics, by use of antipsychoticsa
Table Footer Note

a Data were collected during the 12-month period after the first prescription for an oral antidiabetic (index date).

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b Age at index date

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c McNemar’s test

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d Mean days supplied per fill of oral diabetes medication

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e Calculated by dividing the number of days in which an oral antidiabetic was available by 365.

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f Days of continuous access to an oral antidiabetic

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Table 2Factors associated with adherence to oral antidiabeticsa
Table Footer Note

a Adherence was defined as proportion of days (PDC) covered >.80; PDC was calculated by dividing the number of days in which an oral antidiabetic was available by 365.

Table Footer Note

b Age at first prescription for an oral antidiabetic

Table Footer Note

c Mean days supplied per fill of oral diabetes medication

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