Show simple item record

dc.contributor.authorChan, David Chimin
dc.contributor.authorShrank, William H.
dc.contributor.authorCutler, David M.
dc.contributor.authorJan, Saira
dc.contributor.authorFischer, Michael Adam
dc.contributor.authorLiu, Jun
dc.contributor.authorAvorn, Jerry Lewis
dc.contributor.authorSolomon, Daniel Hal
dc.contributor.authorBrookhart, Alan
dc.contributor.authorChoudhry, Niteesh K
dc.date.accessioned2011-11-08T20:05:51Z
dc.date.issued2010
dc.identifier.citationChan, David C., William H. Shrank, David Cutler, Saira Jan, Michael A. Fischer, Jun Liu, Jerry Avorn, Daniel Solomon, M. Alan Brookhart, and Niteesh K. Choudhry. 2010. Patient, physician, and payment predictors of statin adherence. Medical Care 48(3): 196-202.en_US
dc.identifier.issn0025-7079en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:5343023
dc.description.abstractBACKGROUND: Although many patient, physician, and payment predictors of adherence have been described, knowledge of their relative strength and overall ability to explain adherence is limited. OBJECTIVES: To measure the contributions of patient, physician, and payment predictors in explaining adherence to statins RESEARCH DESIGN: Retrospective cohort study using administrative data SUBJECTS: 14,257 patients insured by Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) who were newly prescribed a statin cholesterol-lowering medication MEASURES: Adherence to statin medication was measured during the year after the initial prescription, based on proportion of days covered (PDC). The impact of patient, physician, and payment predictors of adherence were evaluated using multivariate logistic regression. The explanatory power of these models was evaluated with C statistics, a measure of the goodness of fit. RESULTS: Overall, 36.4% of patients were fully adherent. Older patient age, male gender, lower neighborhood percent black composition, higher median income, and fewer number of emergency department (ED) visits were significant patient predictors of adherence. Having a statin prescribed by a cardiologist, a patient's primary care physician, or a US medical graduate were significant physician predictors of adherence. Lower copayments also predicted adherence. All of our models had low explanatory power. Multivariate models including patient covariates only had greater explanatory power (C = 0.613) than models with physician variables only (C = 0.566) or copayments only (C = 0.543). A fully specified model had only slightly more explanatory power (C = 0.633) than the model with patient characteristics alone. CONCLUSIONS: Despite relatively comprehensive claims data on patients, physicians, and out-of-pocket costs, our overall ability to explain adherence remains poor. Administrative data likely do not capture many complex mechanisms underlying adherence.en_US
dc.description.sponsorshipEconomicsen_US
dc.language.isoen_USen_US
dc.publisherAmerican Public Health Associationen_US
dc.relation.isversionofdoi:10.1097/MLR.0b013e3181c132aden_US
dc.relation.hasversionhttp://scholar.harvard.edu/nkc/publications/patient-physician-and-payment-predictors-statin-adherenceen_US
dash.licenseOAP
dc.subjectadherenceen_US
dc.subjectrelative importanceen_US
dc.subjectexplanatory modelen_US
dc.subjectpatienten_US
dc.subjectphysicianen_US
dc.subjectpaymenten_US
dc.titlePatient, Physician, and Payment Predictors of Statin Adherenceen_US
dc.typeJournal Articleen_US
dc.description.versionAccepted Manuscripten_US
dc.relation.journalMedical Careen_US
dash.depositing.authorCutler, David M.
dc.date.available2011-11-08T20:05:51Z
dc.identifier.doi10.1097/MLR.0b013e3181c132ad*
dash.contributor.affiliatedChan, David Chimin
dash.contributor.affiliatedCutler, David
dash.contributor.affiliatedSolomon, Daniel
dash.contributor.affiliatedShrank, William
dash.contributor.affiliatedAvorn, Jerome
dash.contributor.affiliatedChoudhry, Niteesh
dash.contributor.affiliatedFischer, Michael


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record