Differences may be mediated by health system factors such as co-payment, mail order pharmacies
THURSDAY, Dec. 13 (HealthDay News) -- For adults with hypertension who are new users of antihypertensive medication, racial/ethnic differences in medication-taking behavior occur early in the course of treatment and may be mediated by health system factors, according to a study published online Dec. 10 in the Archives of Internal Medicine.
Alyce S. Adams, Ph.D., from the Kaiser Permanente Division of Research in Oakland, Calif., and colleagues used a hypertension registry to examine potential health system solutions to suboptimal use of antihypertensive therapy. A retrospective cohort study was conducted and included 44,167 adults with hypertension who were new users of antihypertensive agents in 2008.
The researchers found that one in five patients were non-adherent to therapy and more than 30 percent were early non-persistent, with both types of suboptimal behavior more likely in non-whites than whites. After adjustment for sociodemographic, clinical, and health system factors, blacks, Asians, and Hispanics had increased odds of early non-persistence (odds ratios, 1.56, 1.40, and 1.46, respectively) and non-adherence (odds ratios, 1.55, 1.13 [95 percent confidence interval, 1.00 to 1.28], and 1.46, respectively). There was variation in the likelihood of early non-persistence between Asians and Hispanics based on the choice of first-line therapy. When adjusting for medication co-payment and mail-order pharmacy use, racial and ethnic differences in non-adherence were attenuated appreciably.
"Racial/ethnic differences in medication-taking behavior occur early in the course of treatment," the authors write. "However, health system strategies designed to reduce patient co-payments, ease access to medications, and optimize the choice of initial therapy may be effective tools in narrowing persistent gaps in the use of these and other clinically effective therapies."
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