Differences may be mediated by health system factors such as co-payment, mail order pharmacies
THURSDAY, Dec. 13 (HealthDay News) -- For adults with hypertension who are new users of antihypertensive medication, racial/ethnic differences in medication-taking behavior occur early in the course of treatment and may be mediated by health system factors, according to a study published online Dec. 10 in the Archives of Internal Medicine.
Alyce S. Adams, Ph.D., from the Kaiser Permanente Division of Research in Oakland, Calif., and colleagues used a hypertension registry to examine potential health system solutions to suboptimal use of antihypertensive therapy. A retrospective cohort study was conducted and included 44,167 adults with hypertension who were new users of antihypertensive agents in 2008.
The researchers found that one in five patients were non-adherent to therapy and more than 30 percent were early non-persistent, with both types of suboptimal behavior more likely in non-whites than whites. After adjustment for sociodemographic, clinical, and health system factors, blacks, Asians, and Hispanics had increased odds of early non-persistence (odds ratios, 1.56, 1.40, and 1.46, respectively) and non-adherence (odds ratios, 1.55, 1.13 [95 percent confidence interval, 1.00 to 1.28], and 1.46, respectively). There was variation in the likelihood of early non-persistence between Asians and Hispanics based on the choice of first-line therapy. When adjusting for medication co-payment and mail-order pharmacy use, racial and ethnic differences in non-adherence were attenuated appreciably.
"Racial/ethnic differences in medication-taking behavior occur early in the course of treatment," the authors write. "However, health system strategies designed to reduce patient co-payments, ease access to medications, and optimize the choice of initial therapy may be effective tools in narrowing persistent gaps in the use of these and other clinically effective therapies."
Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1485080#Abstract )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1485080 )