Prescriber continuity and medication availability in older adults with cardiometabolic conditions.
Abstract
Background: Many older adults have multiple conditions and see multiple providers,
which may impact their use of essential medications. Objective: We examined whether
the number of prescribers of these medications was associated with the availability
of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia.
Methods: A retrospective cohort of 383,145 older adults with diabetes, hypertension
or dyslipidemia in the US Medicare program living in 10 states. The association between
the number of prescribers of cardiometabolic medications in 2010 and medication availability
(proportion of days with medication on hand) in 2011 was estimated via logistic regression,
controlling for patient demographic characteristics and chronic conditions. Results:
Medicare beneficiaries with diabetes, hypertension and/or dyslipidemia had an average
of five chronic conditions overall, obtained 10-12 medications for all conditions
and most often had one prescriber of cardiometabolic medications. In adjusted analyses,
the number of prescribers was not significantly associated with availability of oral
diabetes agents but having more prescribers is associated with increased medication
availability in older Medicare beneficiaries with dyslipidemia or hypertension. Conclusion:
The incremental addition of new prescribers may be clinically reasonable for complex
patients but creates the potential for coordination problems and informational discontinuity
over time. Health systems may want to identify complex patients with multiple prescribers
to minimize care fragmentation.
Type
Journal articleSubject
Medicarebeneficiary
chronic conditions
compliance
diabetes
dyslipidemia
hypertension
medication
prescribers
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https://hdl.handle.net/10161/16162Published Version (Please cite this version)
10.1177/2050312118757388Publication Info
Maciejewski, Matthew L; Hammill, Bradley G; Voils, Corrine I; Ding, Laura; Bayliss,
Elizabeth A; Curtis, Lesley H; & Wang, Virginia (2018). Prescriber continuity and medication availability in older adults with cardiometabolic
conditions. SAGE Open Med, 6. 10.1177/2050312118757388. Retrieved from https://hdl.handle.net/10161/16162.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Lesley H. Curtis
Professor in Population Health Sciences
Lesley H. Curtis is Professor and Chair of the Department of Population Health Sciences
in the Duke School of Medicine. A health services researcher by training, Dr. Curtis
is an expert in the use of Medicare claims data for health services and clinical outcomes
research, and a leader in national data quality efforts. Dr. Curtis serves as co-PI
of the FDA’s Sentinel Innovation Center, Co-Investigator of the Data Core for the
FDA’s Sentinel Initiative to monitor the safety of
Bradley Gordon Hammill
Associate Professor in Population Health Sciences
Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health
Policy, and Epidemiology
Matthew Leonard Maciejewski
Professor in Population Health Sciences
Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences.
He is also a Senior Research Career Scientist and Director of the Non-randomized Design
Lab in the Center of Innovation to Accelerate Discovery and Practice Transformation
at the Durham VA Medical Center. Matt also holds Adjunct Professor appointments in
the Schools of Public Health and Pharmacy at the University of North Carolina at Chapel
Hill. He has received funding from NIDDK, NIDA, CMS, A
Virginia Wang
Associate Professor in Population Health Sciences
Dr. Virginia Wang is an Associate Professor in Population Health Sciences and Medicine
at the Duke University School of Medicine and Core Faculty in the Duke-Margolis Center
for Health Policy. She is also a Core Investigator in the Health Services Research
Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham
Veterans Affairs Health Care System. Dr. Wang received her PhD in Health Policy and
Management, with a focus on organizational behavior. Her research exa
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