Clinical studyHealth care and medication costs and use among older adults with heart failure☆
Section snippets
Study site
The study site was Wishard Health Services, a tax-supported, public health care system in Indianapolis, Indiana, which includes a 300-bed hospital, emergency department, adjacent ambulatory practices, and citywide network of community-based health care centers. Physicians are faculty of the Indiana University School of Medicine. Wishard pharmacies are located centrally and within the community-based centers, and function under a closed formulary. Electronic medical records from Wishard are
Results
We identified 1554 patients who met our inclusion criteria during the study period (Figure 1). Patients (Table 1) were followed for a mean (± SD) of 2.7 ± 1.5 years, and 356 (23%) died during the study period. About 725 patients received cardiovascular medications annually, of whom 306 (42%) were hospitalized. During the study period, total direct health care costs were nearly $36.6 million, with inpatient costs comprising more than $19 million (52%) of total health care costs. Outpatient
Discussion
We found that only 31% of patients received appropriate supplies of cardiovascular medications (between 90% and 110% of the supplies needed annually). Although we examined medication supplies rather than patient compliance, our results are consistent with previous research that found that patients are typically 40% to 50% compliant with their medication regime 16, 17, 27, 28. In the present study, increasing undersupplies and oversupplies of medications were associated with greater
Acknowledgements
The authors thank Beverly Clark for her assistance in the preparation of this manuscript.
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Cited by (31)
Medication oversupply in patients with diabetes
2015, Research in Social and Administrative PharmacyMedication supply, healthcare outcomes and healthcare expenses: Longitudinal analyses of patients with type 2 diabetes and hypertension
2014, Health PolicyCitation Excerpt :For patients with hypertension, insufficient medication may lead to poorer blood pressure control [2,33], which in turn may increase the risk of adverse events such as myocardial infarction or cerebrovascular disease [34] and lead to of hospitalization and ED visits. Furthermore, this study found that the oversupply of prescribed medication also increased the risk of disease-related hospitalizations and ED visits, findings that are consistent with those of previous studies [10,11,14]. Medication oversupply may involve patients’ taking too much medication or being confused about the use of their medications [35] and may result in adverse events related to medication side effects [36], such as hypoglycemia for patients with diabetes.
Non-compliance with digoxin in patients with heart failure and/or atrial fibrillation: A systematic review and meta-analysis of observational studies
2012, Archives of Cardiovascular DiseasesCitation Excerpt :One study reported prevalence rates at different points of time after discharge; we used the prevalence rate detected at the time closest to those in other included studies [14]. In addition, one study reported outcome of non-compliance as a percentage of compliance but did not define the benchmark for classification as compliant [15]; patients who recorded a compliance percentage greater or equal to 80% were categorized as compliant [16]. Cochrane's risk of bias and the component approach were adopted for assessing study quality [17,18].
The effects of medication supply on hospitalizations and health-care costs in patients with chronic heart failure
2012, Value in HealthCitation Excerpt :We believe that inappropriate supplies of medication are caused not only by behavior of patients or physicians but also by the prescription-dispensing system. Similar to results of the Stroup et al. study [9], our results showed that undersupply and oversupply of medications could increase the risks of CHF-related and all-cause hospitalization. Even though we focused on medication supplies, not particularly on nonadherence to medication, several studies on nonadherence to medication showed that it could worsen CHF symptoms.
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Support for this project was funded in part by the National Institute on Aging (AG19105 and AG07631), Bethesda, Maryland, and the National Heart, Lung, and Blood Institute (HL69399-01), Bethesda, Maryland. The views expressed are solely the authors'.