Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study

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Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study

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dc.contributor.author Adams, Alyce S
dc.contributor.author Piette, John D
dc.contributor.author Trinacty, Connie Mah
dc.contributor.author Soumerai, Stephen Bertram
dc.contributor.author Zhang, Fang
dc.contributor.author Meigs, James Benjamin
dc.contributor.author Ross-Degnan, Dennis
dc.date.accessioned 2011-04-23T14:34:34Z
dc.date.issued 2009
dc.identifier.citation Trinacty, Connie M., Alyce S. Adams, Stephen B. Soumerai, Fang Zhang, James B. Meigs, John D. Piette, and Dennis Ross-Degnan. 2009. Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study. BMC Health Services Research 9: 24. en_US
dc.identifier.issn 1472-6963 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4874787
dc.description.abstract Background: Adherence to oral antidiabetic medications is often suboptimal. Adherence differences may contribute to health disparities for black diabetes patients, including higher microvascular event rates, greater complication-related disability, and earlier mortality. Methods: In this longitudinal retrospective cohort study, we used 10 years of patient-level claims and electronic medical record data (1/1/1992–12/31/2001) to assess differences in short- and long-term adherence to oral antidiabetic medication among 1906 newly diagnosed adults with diabetes (26% black, 74% white) in a managed care setting in which all members have prescription drug coverage. Four main outcome measures included: (1) time from diabetes diagnosis until first prescription of oral antidiabetic medication; (2) primary adherence (time from first prescription to prescription fill); (3) time until discontinuation of oral antidiabetic medication from first prescription; and (4) long-term adherence (amount dispensed versus amount prescribed) over a 24-month follow-up from first oral antidiabetic medication prescription. Results: Black patients were as likely as whites to initiate oral therapy and fill their first prescription, but experienced higher rates of medication discontinuation (HR: 1.8, 95% CI: 1.2, 2.7) and were less adherent over time. These black-white differences increased over the first six months of therapy but stabilized thereafter for patients who initiated on sulfonylureas. Significant black-white differences in adherence levels were constant throughout follow-up for patients initiated on metformin therapy. Conclusion: Racial differences in adherence to oral antidiabetic drug therapy persist even with equal access to medication. Early and continued emphasis on adherence from initiation of therapy may reduce persistent racial differences in medication use and clinical outcomes. en_US
dc.language.iso en_US en_US
dc.publisher BioMed Central en_US
dc.relation.isversionof doi:10.1186/1472-6963-9-24 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645384/pdf/ en_US
dash.license LAA
dc.title Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal BMC Health Services Research en_US
dash.depositing.author Trinacty, Connie Mah
dc.date.available 2011-04-23T14:34:34Z
dash.affiliation.other HMS^Population Medicine en_US
dash.affiliation.other HMS^Population Medicine en_US
dash.affiliation.other HMS^Medicine-Massachusetts General Hospital en_US
dash.affiliation.other HMS^Population Medicine en_US

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