title: Non-adherence to anti-osteoporotic medications in Taiwan: physician specialty makes a difference.
abstract: Adherence to anti-osteoporotic regimens gradually decreases over time. We hypothesized that the determinants of non-compliance or non-persistence at different times vary and identified these differences. We used an outpatient database to retrieve information on anti-osteoporotic medications prescribed by a medical centre in southern Taiwan during 2001-2007. Compliance was defined as a medication possession ratio (MPR) ≥80 %. Persistence was determined as continuous use, allowing for a refill gap of 30 days. A multivariate Cox regression model evaluated potential predictors of non-adherence. A total of 3589 patients were included. In the multivariate analyses, non-compliance for both year 1 and year 2 was more likely in patients with non-vertebral non-hip fractures, respiratory disorders, prescription of the first anti-osteoporotic regimen by an orthopedist; and less likely in patients with follow-up bone densitometry and switched regimens. Risks for non-persistence at year 1 and year 2 were generally similar to those for non-compliance; insurance coverage and malignancy were associated with a lower risk of non-persistence at year 1 and year 2, respectively. In the subgroup with an MPR ≥80 % at year 1, an index prescription by an orthopedist was the only independent predictor of non-compliance and non-persistence at year 2. In conclusion, the positive or negative determinants of non-adherence were different at year 1 and year 2, which indicated that clinicians might deliver effective interventions to improve adherence via different precautions annually. This study also provided evidence that physician specialty had a significant effect on adherence to osteoporosis care.
authors: Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Ta-Pei Road, Niaosung, 833, Kaohsiung, Taiwan.
authors: Shan-Fu
authors: SF
authors: Yu
authors: Tsong-Shing
authors: TS
authors: Yang
authors: Wen-Chan
authors: WC
authors: Chiu
authors: Chung-Yuan
authors: CY
authors: Hsu
authors: Ching-Lan
authors: CL
authors: Chou
authors: Yu-Jih
authors: YJ
authors: Su
authors: Han-Ming
authors: HM
authors: Lai
authors: Ying-Chou
authors: YC
authors: Chen
authors: Chung-Jen
authors: CJ
authors: Chen
authors: Tien-Tsai
authors: TT
authors: Cheng
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008511:Medicine; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000188:drug therapy*; D010349:Patient Compliance; D010820:Physicians; D016016:Proportional Hazards Models; D013624:Taiwan
chemical_list: D050071:Bone Density Conservation Agents
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