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Measuring medication adherence in older community-dwelling patients with multimorbidity

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

Older people with several chronic conditions require multiple drugs from different classes to be adequately treated. This study aims to: (i) measure medication adherence across multiple conditions and therapeutic drug groups in older community-dwelling patients, and (ii) examine the effect of multimorbidity on adherence.

Methods

This is a retrospective cohort study of medication adherence in 855 community-dwelling patients aged ≥ 70 years from 15 practices in Ireland using the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. Multimorbidity was measured using the RxRisk-V and by the number of different drug classes. The RxRisk-V algorithm classifies prescription drug fills into 45 chronic disease classes for older populations based on the WHO Anatomical Therapeutic Chemical classification system. Adherence to medications was assessed by: (i) calculating the average medication possession ratio (MPR) per patient and (ii) an MPR< 80%.

Results

The overall median MPR for the cohort was 0.83 (IQR 0.69, 0.91). The conditions with the highest MPRs were hypothyroidism (mean MPR = 0.88, SD = 0.20) and type 2 diabetes (mean MPR = 0.83, SD = 0.19), followed by heart disease. On average, 20–40% of patients were non-adherent (MPR < 80%) across all conditions. There was an inverted U-shaped relationship between the mean MPR and number of morbidities and drug classes. Adherence varied per patients’ morbidity burden, with higher adherence for certain combinations of chronic conditions.

Conclusion

In total, 31% of older patients with multimorbidity were non-adherent to their medication but adherence levels varied across treatment categories and chronic conditions.

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Acknowledgements

We wish to thank all the study participants and the 15 general practices who kindly gave their time to take part in this study.

Funding

This study was funded by the HRB Research Leader award (RL-2015-1579) and HRB Centre for Primary Care Research (HRC/1/2007).

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Authors and Affiliations

  1. Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street, Dublin, Ireland

    San Kim, Kathleen Bennett & Caitriona Cahir

  2. HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland

    Emma Wallace & Tom Fahey

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  1. San Kim
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  2. Kathleen Bennett
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Correspondence to Caitriona Cahir.

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Kim, S., Bennett, K., Wallace, E. et al. Measuring medication adherence in older community-dwelling patients with multimorbidity. Eur J Clin Pharmacol 74, 357–364 (2018). https://doi.org/10.1007/s00228-017-2388-y

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