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Lower Copayments and Use of Mail-Order Pharmacy may Reduce Disparities in Adherence to Blood-Pressure Medication
Date:12/10/2012

control, with about 87 percent of its members controlling their blood pressure and experiencing concurrent dramatic reductions in strokes and heart attacks.

"This research points to specific strategies that have the potential to reduce disparities in blood pressure by easing access to important medications," Adams said. "Our findings suggest that while racial and ethnic differences in medication adherence persist — even in settings with high-quality care — interventions such as targeted copay reductions and mail-order pharmacy incentives have the potential to reduce these disparities."

Using Kaiser Permanente Northern California's integrated electronic health record system, the researchers identified 44,167 patients who had been prescribed antihypertensive medications for the first time in 2008. Because more than 95 percent of Kaiser Permanente patients obtain prescriptions from the health plan's in-house pharmacy, the researchers were able to monitor when, whether and how these patients refilled their hypertension medications.

Primary nonadherence, or failing to pick up a prescribed medication, was rare. More than one-third of patients failed to refill a medication within 90 days of the first fill (called "early nonpersistence"), and this varied considerably by race. After adjusting for other variables, black (43.6 percent), Asian (38.8 percent) and Latino (41.6 percent) patients all had significantly higher odds of early nonpersistence than white (31 percent) patients.

Nonadherent patients were defined as those with gaps in medication refills for more than 20 percent of the days in the measurement period, or having medication available less than 80 percent of the time. Of the nonadherent patients studied, 28 percent were black, 26.9 percent were Latino, 20.3 percent were Asian, and 16.7 percent were white. The impact of race and ethnicity on nonadherence was significantly reduced when the authors accounted for differences
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SOURCE Kaiser Permanente
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