Pulmonary medication adherence and health-care use in cystic fibrosis

Alexandra Quittner, Jie Zhang, Maryna Marynchenko, Pooja A. Chopra, James Signorovitch, Yana Yushkina, Kristin A. Riekert

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF. METHODS: Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high ( ≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling. R ESULTS: Mean CMPR for the sample (N=3,287) was 48% ≥ 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations 1 ED ) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not diff er by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 ( 2 $1,691 to $19,709 ), respectively, compared with high adherence. C ONCLUSIONS: Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.

Original languageEnglish
Pages (from-to)142-151
Number of pages10
JournalChest
Volume146
Issue number1
DOIs
StatePublished - Jan 1 2014

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Medication Adherence
Cystic Fibrosis
Delivery of Health Care
Lung
Health Care Costs
Hospitalization
Outpatients
Databases
Health

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Quittner, A., Zhang, J., Marynchenko, M., Chopra, P. A., Signorovitch, J., Yushkina, Y., & Riekert, K. A. (2014). Pulmonary medication adherence and health-care use in cystic fibrosis. Chest, 146(1), 142-151. https://doi.org/10.1378/chest.13-1926

Pulmonary medication adherence and health-care use in cystic fibrosis. / Quittner, Alexandra; Zhang, Jie; Marynchenko, Maryna; Chopra, Pooja A.; Signorovitch, James; Yushkina, Yana; Riekert, Kristin A.

In: Chest, Vol. 146, No. 1, 01.01.2014, p. 142-151.

Research output: Contribution to journalArticle

Quittner, A, Zhang, J, Marynchenko, M, Chopra, PA, Signorovitch, J, Yushkina, Y & Riekert, KA 2014, 'Pulmonary medication adherence and health-care use in cystic fibrosis', Chest, vol. 146, no. 1, pp. 142-151. https://doi.org/10.1378/chest.13-1926
Quittner A, Zhang J, Marynchenko M, Chopra PA, Signorovitch J, Yushkina Y et al. Pulmonary medication adherence and health-care use in cystic fibrosis. Chest. 2014 Jan 1;146(1):142-151. https://doi.org/10.1378/chest.13-1926
Quittner, Alexandra ; Zhang, Jie ; Marynchenko, Maryna ; Chopra, Pooja A. ; Signorovitch, James ; Yushkina, Yana ; Riekert, Kristin A. / Pulmonary medication adherence and health-care use in cystic fibrosis. In: Chest. 2014 ; Vol. 146, No. 1. pp. 142-151.
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abstract = "BACKGROUND: Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF. METHODS: Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high ( ≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling. R ESULTS: Mean CMPR for the sample (N=3,287) was 48{\%} ≥ 31{\%}. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95{\%} CI, 1.15-1.57) and moderate (ERR, 1.25; 95{\%} CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations 1 ED ) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not diff er by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 ( 2 $1,691 to $19,709 ), respectively, compared with high adherence. C ONCLUSIONS: Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.",
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N2 - BACKGROUND: Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF. METHODS: Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high ( ≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling. R ESULTS: Mean CMPR for the sample (N=3,287) was 48% ≥ 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations 1 ED ) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not diff er by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 ( 2 $1,691 to $19,709 ), respectively, compared with high adherence. C ONCLUSIONS: Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.

AB - BACKGROUND: Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF. METHODS: Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high ( ≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling. R ESULTS: Mean CMPR for the sample (N=3,287) was 48% ≥ 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations 1 ED ) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not diff er by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 ( 2 $1,691 to $19,709 ), respectively, compared with high adherence. C ONCLUSIONS: Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.

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