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Prescriber continuity and medication availability in older adults with cardiometabolic conditions.

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Date
2018
Authors
Maciejewski, Matthew L
Hammill, Bradley G
Voils, Corrine I
Ding, Laura
Bayliss, Elizabeth A
Curtis, Lesley H
Wang, Virginia
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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 article
Subject
Medicare
beneficiary
chronic conditions
compliance
diabetes
dyslipidemia
hypertension
medication
prescribers
Permalink
https://hdl.handle.net/10161/16162
Published Version (Please cite this version)
10.1177/2050312118757388
Publication 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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Scholars@Duke

Curtis

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
Hammill

Bradley Gordon Hammill

Associate Professor in Population Health Sciences
Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health Policy, and Epidemiology
Maciejewski

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
Wang

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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