title: Determinants of adherence to diabetes medications: findings from a large pharmacy claims database.
abstract: OBJECTIVE
  Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications.
  
  
  METHODS
  We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥ 0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence.
  
  
  RESULTS
  Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent.
  
  
  CONCLUSIONS
  Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence.
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, NC sue_kirkman@med.unc.edu.
authors.forename: M Sue
authors.initials: MS
authors.lastname: Kirkman
authors.affiliation: American Diabetes Association, Alexandria, VA.
authors.forename: Megan T
authors.initials: MT
authors.lastname: Rowan-Martin
authors.affiliation: Express Scripts, Franklin Lakes, NJ.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Levin
authors.affiliation: Tulane University Health Sciences Center, New Orleans, LA.
authors.forename: Vivian A
authors.initials: VA
authors.lastname: Fonseca
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Research and Evaluation Analytics, LLC, Ringwood, NJ.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Aubert
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D015981:Epidemiologic Factors; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010594:Pharmacies / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents