Evidence map›Paper›PMID 28193217›Full record

ArticleBMC health services research2017

Measuring medication adherence in patients with incident hypertension: a retrospective cohort study.

Karen L Tang, Hude Quan, Doreen M Rabi

Registry-linked trialAbstract read
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In one paragraph

Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04752293 (Pediatric Hypertension and the Renin-Angiotensin SystEm), which is not on this map. Cited by 36 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04752293 recruitingnot on this mapstarted 2021, after this paper: background citation

Pediatric Hypertension and the Renin-Angiotensin SystEm (PHRASE): The Role of Angiotensin-(1-7) in Hypertension and Hypertension-Induced Heart and Kidney Damage

TypeobservationalSponsorWake Forest University Health SciencesRan2021 to 2026Enrolled125ConditionsHypertension, Left Ventricular Hypertrophy, Left Ventricular Dysfunction, Left Atrial Dilatation
3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Karen L TangDepartment of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada. klktang@ucalgary.ca.
Hude QuanDepartment of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, Alberta, Canada.
Doreen M RabiDepartment of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada.

Funding

CIHR
6 · The paper itself

Abstract

backgroundThough pharmacy claims data are commonly used to study medication adherence, there remains no standard operational definition for adherence especially for patients on multiple medications. Even when studies use the same terminology, the actual methods of calculating adherence can differ drastically. It is unclear whether the use of different definitions results in different conclusions regarding adherence and associated outcomes. The objective of our study was to compare adherence rates and associations with mortality using different operational definitions of adherence, and using various methods of handling concurrent medication use.

methodsWe conducted a cohort study of patients aged ≥65 years from Manitoba, Canada, with incident hypertension diagnosed in 2004 and followed to 2009. We calculated adherence rates to anti-hypertensive medications using different operational definitions of medication adherence (including interval and prescription based medication possession ratios [MPR] and proportion of days covered [PDC]). For those on concurrent medications, we calculated adherence rates using the different methods of handling concurrent medication use, for each definition. We used logistic regression to determine the association between adherence and mortality for each operational definition.

resultsAmong 2199 patients, 24.1% to 90.5% and 71.2% to 92.7% were considered adherent when using fixed interval and prescription-based interval medication possession ratios [MPRi and MPRp] respectively, depending on how concurrent medications were handled. Adherence was inversely associated with death, with the strongest association for MPRp measures. This association was significant only when considering adherence to any anti-hypertensive [aOR 0.70, 95% CI 0.51, 0.97], or when the mean of the class-specific MPRp's [adjusted OR 0.71, 95% CI 0.53, 0.95] was used. No significant association existed when the highest or lowest class-specific MPRp was used as the adherence estimate.

conclusionThe range of adherence estimates varies widely depending on the operational definition used. Given less variation in adherence rates and their stronger association against mortality, we recommend using prescription-based MPR's to define medication adherence.

Indexed as

Drug MonitoringAdultAgedAged, 80 and overAntihypertensive AgentsDrug PrescriptionsFemaleHumansHypertensionLogistic ModelsMaleManitobaMiddle AgedPharmaceutical ServicesPharmaciesPrescription DrugsAntihypertensive AgentsPrescription DrugsAdherenceClaims dataDrug UtilizationHypertensionPrescription Drugs

Identifiers

PMID28193217
PMCPMC5307770

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.