Abstract
Adherence (or compliance) measures how well the patient takes their medication. Medication persistence measures the duration of time from initiation to discontinuation of therapy and may also consider the intensity of medication-taking behaviour within this interval. Registers on pharmacy claims data have been proposed as the golden standard in medication persistence research. Generally, persistence rate decreases with time. Medication persistence can furthermore be divided into therapy persistence and class persistence. However, these terms are usually not specifically reported in the literature, making results difficult to interpret. One third of hypertensive patients discontinue their medication within 2 years after initiation of treatment. Patient, physician, and health care organization-related factors are associated with medication persistence to antihypertensive treatment. Generally, medication persistence increases with advancing age, is higher in women than in men, and varies with comorbidities. Also, higher income, native-born citizens, and a high number of visits to the physician are all related to increased persistence. Studies on medication persistence are important, as they may be valuable tools in identifying patient groups in need of targeted interventions to improve early blood pressure control and to prevent cardiovascular complications.
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Østbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3(3):209–14.
Harris MF, Zwar NA. Care of patients with chronic disease: the challenge for general practice. Med J Aust. 2007;187(2):104–7.
Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I. Do primary care physicians coordinate ambulatory care for chronic disease patients in Canada? BMC Fam Pract. 2014;15:148.
Carlsson AC, Wändell P, Ösby U, Zarrinkoub R, Wettermark B, Ljunggren G. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden—a challenge for public health. BMC Public Health. 2013;13:670.
Wallentin F, Wettermark B, Kahan T. Current antihypertensive drug therapy in Sweden in relation to gender, age, and comorbidity. J Clin Hypertens. 2018;20(1):106–14.
Friedman O, McAlister FA, Yun L, Campbell NR, Tu K. Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario. Am J Med. 2010;123(2):173–81.
Qvarnström M, Kahan T, Kieler H, et al. Persistence to antihypertensive drug treatment in Swedish primary healthcare. Eur J Clin Pharmacol. 2013;69(11):1955–64.
Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.
Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.
Caetano PA, Lam JM, Morgan SG. Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. Clin Ther. 2006;28(9):1411–24.
Vrijens B, Heidbuchel H. Non-vitamin K antagonist oral anticoagulants: considerations on once- vs. twice-daily regimens and their potential impact on medication adherence. Europace. 2015;17(4):514–23.
Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62(1):76–87.
Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Refill persistence with chronic medication assessed from a pharmacy database was influenced by method of calculation. J Clin Epidemiol. 2006;59:11–7.
Kothari C, Garg G. Research methodology: methods and techniques. 3rd ed. New Delhi: New Age International Publishers; 2014.
Eriksson I, Ibanez L. Secondary data sources for drug utilization research. In: Elseviers M, Wettermark B, Almadóttir AB, et al., editors. Drug utilization research—methods and applications. Wiley: Chichester; 2016.
Simons LA, Ortiz M, Calcino G. Persistence with antihypertensive medication: Australia-wide experience, 2004-2006. Med J Aust. 2008;188(4):224–7.
Cooke CE, Xing S, Lee HY, Belletti DA. You wrote the prescription, but will it get filled? J Fam Pract. 2011;60(6):321–7.
Rognehaugh R. The health information technology dictionary. Gaithersburg: Aspen Publishers; 1999.
The National Academies Collection: Reports funded by National Institutes of Health. In: Nass SJ, Levit LA, Gostin LO, editors. Beyond the HIPAA privacy rule: enhancing privacy, improving health through research. Washington, DC: National Academies Press (US); 2009.
Turn R, Ware WH. Privacy and security issues in information systems. Santa Monica: The RAND Corporation; 1976.
Beauchamp TL, Childres JF. Principles of biomedical ethics. 3rd ed. New York: Oxford University Press; 1989.
Merz JF, editor. A survey of international ethics practices in pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf. 2001;10:577–708.
Olsen J. Data protection and epidemiological research: a new EU regulation is in the pipeline. Int J Epidemiol. 2014;43(5):1353–4.
Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice. CMAJ. 1999;160(1):31–7.
Bourgault C, Senecal M, Brisson M, Marentette MA, Gregoire JP. Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study. J Hum Hypertens. 2005;19(8):607–13.
Perreault S, Lamarre D, Blais L, et al. Persistence with treatment in newly treated middle-aged patients with essential hypertension. Ann Pharmacother. 2005;39(9):1401–8.
Burke TA, Sturkenboom MC, Lu SE, Wentworth CE, Lin Y, Rhoads GG. Discontinuation of antihypertensive drugs among newly diagnosed hypertensive patients in UK general practice. J Hypertens. 2006;24(6):1193–200.
Elliott WJ, Plauschinat CA, Skrepnek GH, Gause D. Persistence, adherence, and risk of discontinuation associated with commonly prescribed antihypertensive drug monotherapies. J Am Board Fam Med. 2007;20(1):72–80.
Hasford J, Schröder-Bernhardi D, Rottenkolber M, Kostev K, Dietlein G. Persistence with antihypertensive treatments: results of a 3-year follow-up cohort study. Eur J Clin Pharmacol. 2007;63(11):1055–61.
Patel BV, Remigio-Baker RA, Mehta D, Thiebaud P, Frech-Tamas F, Preblick R. Effects of initial antihypertensive drug class on patient persistence and compliance in a usual-care setting in the United States. J Clin Hypertens (Greenwich). 2007;9(9):692–700.
Corrao G, Zambon A, Parodi A, et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J Hypertens. 2008;26(4):819–24.
Vinker S, Alkalay A, Hoffman RD, Elhayany A, Kaiserman I, Kitai E. Long-term adherence to antihypertensive therapy: a survey in four primary care clinics. Expert Opin Pharmacother. 2008;9(8):1271–7.
Saleh SS, Szebenyi S, Carter JA, Zacher C, Belletti D. Patterns and associated health services costs of antihypertensive drug modifications. J Clin Hypertens (Greenwich). 2008;10(1):43–50.
Wong MC, Jiang JY, Gibbs T, Griffiths SM. Factors associated with antihypertensive drug discontinuation among Chinese patients: a cohort study. Am J Hypertens. 2009;22(7):802–10.
Nicotra F, Wettermark B, Sturkenboom MC, et al. Management of antihypertensive drugs in three European countries. J Hypertens. 2009;27(9):1917–22.
Tamblyn R, Abrahamowicz M, Dauphinee D, et al. Influence of physicians’ management and communication ability on patients’ persistence with antihypertensive medication. Arch Intern Med. 2010;170(12):1064–72.
Trimarco V, de Simone G, Izzo R, et al. Persistence and adherence to antihypertensive treatment in relation to initial prescription: diuretics versus other classes of antihypertensive drugs. J Hypertens. 2012;30(6):1225–32.
Ishisaka DY, Jukes T, Romanelli RJ, Wong KS, Schiro TA. Disparities in adherence to and persistence with antihypertensive regimens: an exploratory analysis from a community-based provider network. J Am Soc Hypertens. 2012;6(3):201–9.
Selmer R, Blix HS, Landmark K, Reikvam A. Choice of initial antihypertensive drugs and persistence of drug use—a 4-year follow-up of 78,453 incident users. Eur J Clin Pharmacol. 2012;68(10):1435–42.
Mancia G, Zambon A, Soranna D, Merlino L, Corrao G. Factors involved in the discontinuation of antihypertensive drug therapy: an analysis from real life data. J Hypertens. 2014;32(8):1708–15.
Ah YM, Lee JY, Choi YJ, et al. Persistence with antihypertensive medications in uncomplicated treatment-naive patients: effects of initial therapeutic classes. J Korean Med Sci. 2015;30(12):1800–6.
Qvarnström M, Kahan T, Kieler H, et al. Persistence to antihypertensive drug classes: a cohort study using the Swedish Primary Care Cardiovascular Database (SPCCD). Medicine (Baltimore). 2016;95(40):e4908.
Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Hum Hypertens. 2004;18(9):607–13.
Hansen RA, Voils CI, Farley JF, et al. Prescriber continuity and medication adherence for complex patients. Ann Pharmacother. 2015;49(3):293–302.
Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825–34.
Nieburg I, Kahan T. How to improve risk factor evaluation of hypertensive patients in primary care. Blood Press. 2010;19:176–81.
Holmquist C, Hasselström J, Hjerpe P, et al. Improved treatment and control of hypertension in Swedish primary care: results from the Swedish Primary Care Cardiovascular Database (SPCCD). J Hypertens. 2017;35:2102–8.
Gervas J, Perez Fernandez M, Starfield BH. Primary care, financing and gatekeeping in western Europe. Fam Pract. 1994;11:307–17.
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Qvarnström, M., Wettermark, B., Kahan, T. (2018). Medication Persistence in Hypertension in General Practice. In: Burnier, M. (eds) Drug Adherence in Hypertension and Cardiovascular Protection. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-76593-8_13
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