Variation in adherence to medications across the healthcare system in two comparative effectiveness research cohorts
Abstract
Aim: To assess heterogeneity in adherence to medications in two example comparative effectiveness research studies. Patients & methods: We analyzed data from commercially insured patients initiating a statin or anticoagulant during 2005–2012. We calculated the cross-validated R2 from a series of hierarchical linear models to assess variation in 1-year adherence. Results: There was less heterogeneity in adherence in the statin cohort compared with the anticoagulant cohort, where patient characteristics explained 7.2% of variation in adherence, and adding therapy and provider characteristics increased the proportion of variation explained to 8.0 and 8.5%, cumulatively. Random effects provided essentially no explanatory power, even in the statin cohort with large numbers of patients clustered within each pharmacy, prescriber and provider. Conclusion: The dependence of adherence on the healthcare system was stronger when the healthcare system influenced treatment choice and patient access to medication and when indications for treatment were strong.
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© 2017 Future Medicine Ltd.
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Received: 16 December 2016
Accepted: 19 June 2017
Published online: 17 October 2017
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Variation in adherence to medications across the healthcare system in two comparative effectiveness research cohorts. (2017) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2016-0095
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