Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus.

Abstract

OBJECTIVE:

We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (ISMs) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE).

METHODS:

We utilized US Medicaid data from 2000-2006 to identify adults ages 18-64 years with SLE who were new users of HCQ or ISMs. We defined the index date as receipt of HCQ or ISMs without use in the prior 6 months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days' supply dispensed, for the 1-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR <80%) and acute care utilization, adjusting for sociodemographics and comorbidities.

RESULTS:

We identified 9,600 HCQ new users and 3,829 ISM new users with SLE. The mean ± SD MPR for HCQ was 47.8% ± 30.3% and for ISMs was 42.7% ± 30.7%. Seventy-nine percent of HCQ users and 83% of ISM users were nonadherent (MPR <80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% confidence interval [95% CI] 1.43-1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25-1.50), comparing nonadherers to adherers. For ISM users, the IRR of ED visits was 1.64 (95% CI 1.42-1.89) and of hospitalizations was 1.67 (95% CI 1.41-1.96) for nonadherers versus adherers.

CONCLUSION:

In this cohort, nonadherence to HCQ and ISMs was common and was associated with significantly higher subsequent acute care utilization.

• Authors: Candace H Feldman, Jinoos Yazdany, Hongshu Guan, Daniel H Solomon, Karen H Costenbader
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 67 Issue 12 Pg. 1712-21 (Dec 2015) ISSN: 2151-4658 [Electronic] United States
• PMID: 26097166 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015, American College of Rheumatology.

Chemical References

• Antirheumatic Agents
• Immunosuppressive Agents
• Hydroxychloroquine

Topics

• Adolescent
• Adult
• Antirheumatic Agents (therapeutic use)
• Chi-Square Distribution
• Databases, Factual
• Emergency Service, Hospital (statistics & numerical data)
• Female
• Health Resources (statistics & numerical data)
• Hospitalization
• Humans
• Hydroxychloroquine (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Insurance Benefits
• Lupus Erythematosus, Systemic (diagnosis, drug therapy, epidemiology)
• Male
• Medicaid
• Medication Adherence
• Middle Aged
• Multivariate Analysis
• Prevalence
• Time Factors
• United States (epidemiology)
• Young Adult