TY - JOUR
T1 - Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus
AU - Learnihan, Vincent
AU - Schroers, Ralf-D
AU - Coote, Philip
AU - Blake, Marcus
AU - Coffee, Neil T
AU - Daniel, Mark
N1 - Funding Information:
This research was conducted as part of research project 3348 - Spatial Management of Health Risk funded by the Australian Digital Health Cooperative Research Centre (DHCRC) in collaboration with industry partner HMS (since acquired by Gainwell Technologies). We would like to acknowledge Donna Price, Dr Gary Call, MD, Ellen Harrison, Jason Cooper, Evan Caten and Prof Rachel Davey for their contributions to this research.
Publisher Copyright:
© 2021
PY - 2022/3
Y1 - 2022/3
N2 - Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.
AB - Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.
KW - Diabetes
KW - Geographic variation
KW - Medication adherence
KW - Proportion days covered
KW - Social determinants
KW - Social vulnerability
UR - http://www.scopus.com/inward/record.url?scp=85122955467&partnerID=8YFLogxK
U2 - 10.1016/j.ssmph.2021.101013
DO - 10.1016/j.ssmph.2021.101013
M3 - Article
C2 - 35106360
AN - SCOPUS:85122955467
SN - 2352-8273
VL - 17
SP - 1
EP - 11
JO - SSM - Population Health
JF - SSM - Population Health
M1 - 101013
ER -