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


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.





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Publication Info

Maciejewski, Matthew L, Bradley G Hammill, Corrine I Voils, Laura Ding, Elizabeth A Bayliss, Lesley H Curtis and Virginia Wang (2018). Prescriber continuity and medication availability in older adults with cardiometabolic conditions. SAGE Open Med, 6. 10.1177/2050312118757388 Retrieved from

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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, AHRQ, VA HSR&D, and the RWJ Foundation to conduct evaluation of long-term clinical and economic outcomes of surgical interventions, behavioral interventions and Medicare program/policy changes on patients with obesity or cardiometabolic conditions.  He is also interested in methods for addressing unobserved confounding in observational studies.  Matt evaluated the first-ever population-based implementation of value-based insurance design and led the first-ever linkage of lab results and Medicare FFS claims.  He has published over 250 papers in peer-reviewed journals such as JAMA, JAMA Internal Medicine, JAMA Surgery, Annals of Internal Medicine, Health Economics, Medical Care, Health Services Research, Journal of Clinical Epidemiology and Diabetes Care.

Areas of expertise: Health Services Research, Health Economics, Health Policy, Multimorbidity


Bradley Gordon Hammill

Associate Professor in Population Health Sciences

Brad Hammill, DrPH, is an Associate Professor in the Department of Population Health Sciences within the School of Medicine and a member of the Duke Clinical Research Institute. Dr. Hammill received his DrPH in Biostatistics from The University of North Carolina at Chapel Hill. His research is focused on leveraging real-world data—including electronic health record data, health insurance claims data, and registry data—for clinical research.

Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health Policy, and Epidemiology


Lesley H. Curtis

Professor in Population Health Sciences

Lesley H. Curtis is Professor in the Departments of Population Health Sciences and Medicine in the Duke School of Medicine and was inaugural chair of the Department of Population Health Sciences.  A health services researcher by training, Dr. Curtis is an expert in the use of health care and Medicare claims data for health services and clinical outcomes research, and a leader in national data quality efforts. Dr. Curtis has led the linkage of Medicare claims with several large clinical registries and epidemiological cohort studies including the Framingham Heart Study and the Cardiovascular Health Study. Dr. Curtis currently serves as a senior policy advisor at the Food and Drug Administration supporting the Agency’s evidence generation initiative, and is co-PI of the NIH Pragmatic Trials Collaboratory, an NIH initiative to strengthen the national capacity for large-scale research studies embedded in health care delivery.

Areas of expertise: Health Services Research and Health Policy



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 examines organizational influences and policy on the provision of health services, provider strategy and performance, care coordination, and outcomes for patients with complex chronic disease.

Dr. Wang’s research has been supported by the Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases, Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services Office of Minority Health.

Areas of expertise:  health services research, organizational behavior, health policy, implementation and program evaluation

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