Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing

Abstract

Background:

The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear.

Objective:

To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization.

Methods:

This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented.

Results:

Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate.

Conclusion and Relevance:

Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

Keywords

adherence multimorbidity aged aged 80 and older hospitalization general practice emergency service hospital

Get full access to this article

View all access options for this article.

References

Vrijens

De Geest

Hughes

, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73:691-705. doi:10.1111/j.1365-2125.2012.04167.x

Hughes

CM.

Medication non-adherence in the elderly: how big is the problem?

Drugs Aging. 2004;21:793-811. doi:10.2165/00002512-200421120-00004

Walsh

Cahir

Tecklenborg

Byrne

Culbertson

Bennett

KE.

The association between medication non-adherence and adverse health outcomes in ageing populations: a systematic review and meta-analysis. Br J Clin Pharmacol. 2019;85:2464-2478. doi:10.1111/bcp.14075

Pednekar

Ágh

Malmenäs

, et al. Methods for measuring multiple medication adherence: a systematic review—report of the ISPOR Medication Adherence and Persistence Special Interest Group. Value Health. 2019;22:139-156. doi:10.1016/j.jval.2018.08.006

Nagin

Odgers

CL.

Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109-138. doi:10.1146/annurev.clinpsy.121208.131413

Franklin

Krumme

Tong

, et al. Association between trajectories of statin adherence and subsequent cardiovascular events. Pharmacoepidemiol Drug Saf. 2015;24:1105-1113. doi:10.1002/pds.3787

Lo-Ciganic

Donohue

Jones

, et al. Trajectories of diabetes medication adherence and hospitalization risk: a retrospective cohort study in a large state Medicaid program. J Gen Intern Med. 2016;31:1052-1060. doi:10.1007/s11606-016-3747-6

Dillon

Smith

Gallagher

Cousins

The association between pharmacy refill-adherence metrics and healthcare utilisation: a prospective cohort study of older hypertensive adults. Int J Pharm Pract. 2019;27:459-467. doi:10.1111/ijpp.12539

Marengoni

Angleman

Melis

, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10:430-439. doi:10.1016/j.arr.2011.03.003

10.

Glynn

Valderas

Healy

, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28:516-523. doi:10.1093/fampra/cmr013

11.

Walsh

Bennett

Wallace

Cahir

. Identifying adherence patterns across multiple medications and their association with health outcomes in older community-dwelling adults with multimorbidity. Value Health. In press

12.

Wallace

Salisbury

Guthrie

Lewis

Fahey

Smith

SM.

Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176. doi:10.1136/bmj.h176

13.

Kenny

Whelan

Cronin

, et al. The design of the Irish Longitudinal Study on Ageing. Published 2010. Accessed March 11, 2020. https://tilda.tcd.ie/publications/reports/pdf/Report_DesignReport.pdf

14.

Barrett

Burke

Cronin

, et al. Fifty plus in Ireland 2011: first results from the Irish Longitudinal Study on Ageing (TILDA). Accessed June 15, 2020. https://www.lenus.ie/handle/10147/129741

15.

Sinnott

S-J

Bennett

Cahir

Pharmacoepidemiology resources in Ireland—an introduction to pharmacy claims data. Eur J Clin Pharmacol. 2017;73:1449-1455. doi:10.1007/s00228-017-2310-7

16.

Central Statistics Office. Women and men in Ireland 2013: Health list. Accessed December 11, 2018. https://www.cso.ie/en/releasesandpublications/ep/p-wamii/womenandmeninireland2013/healthlist/health/#d.en.65619

17.

Vitry

Wong

Roughead

Ramsay

Barratt

Validity of medication-based co-morbidity indices in the Australian elderly population. Aust NZ J Public Health. 2009;33:126-130. doi:10.1111/j.1753-6405.2009.00357.x

18.

Sloan

Sales

Liu

, et al. Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument. Med Care. 2003;41:761-774.

19.

Pratt

Kerr

Barratt

, et al. The validity of the Rx-Risk Comorbidity Index using medicines mapped to the Anatomical Therapeutic Chemical (ATC) classification system. BMJ Open. 2018;8:e021122. doi:10.1136/bmjopen-2017-021122

20.

Vollmer

Feldstein

Smith

Waterbury

Rand

Comparison of pharmacy-based measures of medication adherence. BMC Health Serv Res. 2012;12:155. doi:10.1186/1472-6963-12-155

21.

Dima

Dediu

Computation of adherence to medication and visualization of medication histories in R with AdhereR: towards transparent and reproducible use of electronic healthcare data. PLoS One. 2017;12:e0174426. doi:10.1371/journal.pone.0174426

22.

Walsh

Cahir

Bennett

KE.

Association between adherence to antihypertensive medications and health outcomes in middle and older aged community dwelling adults; results from the Irish longitudinal study on ageing. Eur J Clin Pharmacol. 2019;75:1283-1292. doi:10.1007/s00228-019-02699-w

23.

Radloff

LS.

The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385-401.

24.

Theou

O’Connell

MDL

King-Kallimanis

O’Halloran

Rockwood

Kenny

RA.

Measuring frailty using self-report and test-based health measures. Age Ageing. 2015;44:471-477. doi:10.1093/ageing/afv010

25.

Roe

Normand

Wren

Browne

O’Halloran

AM.

The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish Longitudinal Study on Ageing. BMC Geriatr. 2017;17:203. doi:10.1186/s12877-017-0579-0

26.

Shrank

Patrick

Alan Brookhart

Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. J Gen Intern Med. 2011;26:546-550. doi:10.1007/s11606-010-1609-1

27.

Cameron

Trivedi

PK.

Regression Analysis of Count Data. Vol 53. Cambridge University Press; 2013.

28.

Osterberg

Blaschke

Adherence to medication. N Engl J Med. 2005;353:487-497. doi:10.1056/NEJMra050100

29.

Cross

Elliott

Petrie

Kuruvilla

George

Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev. 2020;5(5):CD012419. doi:10.1002/14651858.CD012419

30.

Wallace

Moriarty

McGarrigle

Smith

Kenny

Fahey

Self-report versus electronic medical record recorded healthcare utilisation in older community-dwelling adults: comparison of two prospective cohort studies. PLoS One. 2018;13:e0206201. doi:10.1371/journal.pone.0206201

31.

Tang

Quan

Rabi

DM.

Measuring medication adherence in patients with incident hypertension: a retrospective cohort study. BMC Health Serv Res. 2017;17:135. doi:10.1186/s12913-017-2073-y

32.

Conn

Ruppar

TM.

Medication adherence outcomes of 771 intervention trials: systematic review and meta-analysis. Prev Med. 2017;99:269-276. doi:10.1016/j.ypmed.2017.03.008

33.

Rankin

Cadogan

Patterson

, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018;9(9):CD008165. doi:10.1002/14651858.CD008165.pub4

34.

Patton

Francis

Clark

, et al. A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol. Pilot Feasibility Stud. 2019;5:116. doi:10.1186/s40814-019-0506-6

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.33 MB