Medication compliance and disease exacerbation in patients with asthma: a retrospective study of managed care data
Authors: Stern, Lee; Berman, Jeff; Lumry, William; Katz, Laura; Wang, Lujing; Rosenblatt, Lisa; Doyle, John J.
Source: Annals of Allergy, Asthma and Immunology, Volume 97, Number 3, September 2006 , pp. 402-408(7)
Publisher: American College of Allergy, Asthma, & Immunology
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Abstract:
Background: Compliance with asthma medications probably results in improved outcomes, but few studies have examined this relationship. Objective: To examine the association between medication compliance and exacerbation in asthmatic patients. Methods: Retrospective analysis of a managed care database. The 97,743 participants (aged 6-99 years; mean age, 32.8 years) had asthma and prescriptions for controller medications. Compliance with the index medication (the first controller medication prescribed) was measured using 2 methods: medication possession ratio (MPR), calculated for 365 days after the index date, and number of prescriptions for each index medication. Exacerbation was defined as 1 or more emergency department visits or hospitalizations within 1 year of the index date. Multivariate models were used to determine the odds of exacerbation based on relative compliance for each definition of compliance. Results: Based on the median MPR, more-compliant patients were less likely to experience exacerbation than less-compliant patients (odds ratio, 0.94; 95% confidence interval, 0.91-0.97; P < .001). Using the 75th percentile MPR, risk of exacerbation was even smaller (odds ratio, 0.89; 95% confidence interval, 0.86-0.92; P < .001). All the cutoff points for compliance (≥2 through ≥6 prescriptions) demonstrated significantly less exacerbations in more-compliant vs less-compliant patients after adjusting for covariates. As the criteria for compliance became more stringent, more-compliant patients became increasingly less likely to have an exacerbation vs less-compliant patients. Conclusion: More-compliant asthmatic patients were significantly less likely to experience exacerbation than less-compliant asthmatic patients. These findings demonstrate the importance of improving medication compliance among asthmatic patients to impact outcomes.Document Type: Original article
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