title: Impact of medication adherence on health care utilization and productivity: self-reported data from a cohort of postmenopausal women on osteoporosis therapy.
abstract: BACKGROUND
  Many pharmacologic agents are approved for the prevention and treatment of osteoporosis, which is common among postmenopausal women. Evidence exists relating treatment persistence to fracture risk. Less is known about treatment persistence and the use of health care service and individual productivity.
  
  
  OBJECTIVE
  This study was undertaken to describe health care use and productivity loss relative to osteoporosis medication persistence using women's self-reported data from the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™), a large, longitudinal (October 2004-December 2009) osteoporosis cohort study of postmenopausal women.
  
  
  METHODS
  Analyses included women on pharmacologic osteoporosis therapy (alendronate, risedronate, ibandronate, calcitonin, raloxifene, or teriparatide) who provided health care use/productivity data collected using semiannual questionnaires over 1 year of follow-up. Participant characteristics, use, and productivity metrics were summarized. Logistic regression models and generalized linear models were used to examine use, time missed from usual activities, number of days spent in bed, and lost work time relative to treatment persistence, adjusting for potential confounders.
  
  
  RESULTS
  At entry, of the 2528 women studied (91% white, 3.1% Hispanic/Latino, 2.3% African American/black, 1.1% Asian, and 2.1% American Indian/Native Alaskan, Native Hawaiian/Pacific Islander, or other; mean age, 64.6 [range, 37-97] years), 43.1% had osteoporosis and 23.4% had a previous fracture. After adjustment, subjects who switched therapies during follow-up were more likely to have had any kind of diagnostic testing (95.2% of switchers vs 91.2% of persistent subjects and 88.9% of discontinuers, P < 0.05). Discontinuers were less likely than persistent subjects to visit their primary care physicians (92.0% vs 94.4%, P = 0.0337). Variations in the number of days spent in bed, time missed from usual activities, and work loss (n = 852 employed subjects) by treatment persistence were not significant.
  
  
  CONCLUSIONS
  Use of diagnostic testing differed significantly by osteoporosis treatment status. Compared with women who persisted with treatment, primary care provider visits were less common among those who discontinued treatment. Treatment persistence was not associated with significant differences in productivity measures.
authors.affiliation: Wade Outcomes Research and Consulting, Salt Lake City, Utah 84102, USA. sallyw@amgen.com
authors.forename: Sally W
authors.initials: SW
authors.lastname: Wade
authors.forename: Sacha
authors.initials: S
authors.lastname: Satram-Hoang
authors.forename: Aalok
authors.initials: A
authors.lastname: Nadkar
authors.forename: David
authors.initials: D
authors.lastname: Macarios
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D057915:Drug Substitution; D004526:Efficiency; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D055118:Medication Adherence; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D057566:Self Report; D012737:Sex Factors; D018582:Sick Leave; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents