• Clinical and economic impact of statin therapy compliance on hyperlipidemic patients with concomitant CHD risk factors

      Samant, Navendu Dinanath; Shaya, Fadia T. (2010)
      In cholesterol management, a common and widely used class of drug is 3-hydroxyl-3-methylglutaryl coenzyme A reductase inhibitor (statin). These drugs lower cholesterol by slowing down the production of cholesterol and by increasing the liver's ability to remove LDL cholesterol already in the blood. Statins are well tolerated, and serious side effects such as liver problems, muscle soreness, pain, and weakness are rare. Compliance to prescribed medication is an important component of appropriate pharmacotherapy. Maryland Medicaid managed care (MCO) data were used to examine risk factors of patient non-compliance to statin therapy and its impact on healthcare utilization and the risk of having a new cardiovascular event among patients with hyperlipidemia and one or more CHD risk factors. The sample included Maryland Medicaid MCO patients who were diagnosed with hyperlipidemia and an additional CHD risk factor and were statin drug users. The proportion of patients compliant to statin therapy was 38 percent. The average age of the sample was 50. Over half of the sample was African American (50.69 percent), the rest Caucasian (41.54 percent) and Others (7.77 percent). Results for predictors of statin therapy compliance indicated that age and race had a significant impact on compliance. Although statistically non-significant, compliance was higher among patients with higher Charlson Comorbidity Index (CCI) scores. The probability of being compliant to statin therapy increased with age. African Americans (odds ratio = 0.662, 95 percent CI = 0.580-0.756) and Other race (odds ratio = 0.689, 95 percent CI = 0.549-0.865) groups were less compliant to statin therapy than Caucasians. The cost model indicated that compliant patients did not differ in cardiovascular disease (CVD) related medical costs from semi-compliant or non-compliant patients. The results of the CV risk model indicated that patients who were compliant to statin therapy had lower risk of a cardiovascular event than patients not compliant to statins and the findings were statistically significant. In conclusion, the study did not find significant evidence to prove that compliant patients would have lower CVD related costs. Risk of CV event was lower in compliant patients and was statistically significant. The study was conducted from January 1, 2002 through June 31, 2005. Future studies could examine the impact of compliance over a longer period of time in the Medicaid population.
    • Effects of Self-Efficacy and Heatlh Literacy on Adherence to Self-Care Behaviors in Kidney Transplant Patients

      Campbell, Michelle Lynn; Pradel, Francoise G. (2014)
      Kidney transplant recipients (KTRs) have to take multiple daily medications, look for signs of acute rejection, have frequent blood draws and often manage additional chronic conditions. Appropriate management of the transplanted kidney is crucial to minimize the potential for graft failure and a return to the transplant wait list. There is a limited knowledge on underlying behavioral factors that may influence KTRs' adherence to self-care behaviors and the impact of adherence to self-care behaviors on the occurrence of patient safety events. This study aims to 1) Describe variations of self-efficacy based on individual KTRs'characteristics, 2) Explore the association between self-efficacy, health literacy and adherence to self-care behaviors and 3) Explore the association between adherence to self-care behaviors and patient safety events (diarrhea and hypoglycemia). Four hundred and thirty-five eligible KTRs received a survey inquiring about self-efficacy, health literacy, social support, medication adherence, self-care behaviors and patient safety events. Linear regression analyzed variations of self-efficacy in KTRs. Self-efficacy was tested as a mediator or as a moderator of health literacy on adherence to self-care behaviors. Logistic regression analyzed associations between adherence to self-care behaviors and patient safety events. One hundred and eighty-two KTRs completed the survey (42% participation rate). Mean age of responders was 59.5 (+/-12.1) years; 61.0% were male; and 38.1% were African American. The mean time since transplant was 38.0 (+/- 18.1) months. Being African American was associated with lower self-efficacy (β= -0.61, p=0.03) while an increase in functional health literacy was associated with an increase in self-efficacy (β=0.72, p<0.01). Self-efficacy was a partial mediator of functional and communicative health literacy on adherence to self-care behaviors (functional: αβ=0.32, CI: 0.11-0.60; communicative: αβ=0.37,CI: 0.11-0.71). There was no association between adherence to self-care behaviors and patient safety events. Clinicians need to monitor patients with low self-efficacy and low health literacy. Teach-back method and frequent communication can help increase self-efficacy. Use of larger font, photos and visual cues will help patients with limited health literacy. These methods may optimize KTRs' adherence to self-care behaviors.