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Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands

2019-11Journal article Open access
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dc.contributor.authorAlfian, Sofa D.
dc.contributor.authorDenig, Petra
dc.contributor.authorCoelho, André
dc.contributor.authorHak, Eelko
dc.date.accessioned2019-12-02T11:52:20Z
dc.date.available2019-12-02T11:52:20Z
dc.date.issued2019-11
dc.description.abstractBackground - Adherence to antihypertensive drugs in patients with diabetes is important. To support adherence, attention should be paid to the dynamic process of implementation, persistence, and reinitiation of these drugs. We assessed non-adherence, non-persistence and reinitiation patterns for antihypertensive drugs in patients on oral diabetes drugs and identified pharmacy-based predictors of these processes. Methods - We conducted a cohort study in patients on oral diabetes drugs who initiated antihypertensive drugs between 1995-2015, as registered in the IADB.nl pharmacy database. Non-adherence was defined as a medication possession ratio < 80% and non-persistence as a gap > 180 days. We defined reinitiation as the dispensing of an antihypertensive drug within one year following discontinuation. We provide descriptive statistics for different time periods and applied logistic and Cox regressions to assess associations with sociodemographic and drug-related factors. Results - Of 6,669 initiators, non-adherence rates in persistent patients decreased from 11.0% in the first year to 8.5% and 7.7% in the second and third years, respectively. Non-persistence rates decreased from 18.0% in the first year to 3.7% and 2.9% in the second and third years, respectively. Of the 1,201 patients who discontinued in the first year, 22.0% reinitiated treatment within one year. Non-adherence and non-persistence rates were lower in the more recent time period. Predictors of non-adherence were secondary prevention (OR: 1.45; 95% CI: 1.10-1.93) and diuretics as initial drug class (OR: 1.37; 95% CI: 1.08-1.74). Predictors of non-persistence were female gender (HR: 1.18; 95% CI: 1.05-1.32), older age (HR: 1.33; 95% CI: 1.08-1.63) and diuretics, beta-blocking agents or calcium channel blockers as an initial drug class. Longer duration of persistence was a predictor of reinitiation. Conclusions - Adherence to antihypertensive drugs in patients on oral diabetes drugs has improved over time. The first year after initiation is the most crucial with regard to non-adherence and non-persistence, and the risk groups are different for both processes. Early non-persistence is a risk factor for not reinitiating treatment.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAlfian SD, Denig P, Coelho A, Hak E. Pharmacy-based predictors of nonadherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands. PLoS ONE. 2019;14(11):e0225390.pt_PT
dc.identifier.doi10.1371/journal.pone.0225390pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.21/10780
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherPLOSpt_PT
dc.relation.publisherversionhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225390pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectPharmacologypt_PT
dc.subjectAntihypertensive drugspt_PT
dc.subjectDrug adherencept_PT
dc.subjectDiabetespt_PT
dc.subjectDrug therapypt_PT
dc.subjectAntihypertensivespt_PT
dc.subjectDiureticspt_PT
dc.subjectCalcium channelspt_PT
dc.subjectPatient compliancept_PT
dc.subjectNetherlandspt_PT
dc.titlePharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlandspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue11pt_PT
oaire.citation.startPagee0225390pt_PT
oaire.citation.titlePLoS ONEpt_PT
oaire.citation.volume14pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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