Variation in Medication Adherence in Heart Failure | Cardiology | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.204.227.34. Please contact the publisher to request reinstatement.
1.
Zhang Y, Baicker K, Newhouse JP. Geographic variation in Medicare drug spending.  N Engl J Med. 2010;363(5):405-40920538621PubMedGoogle ScholarCrossref
2.
Zhang Y, Baicker K, Newhouse JP. Geographic variation in the quality of prescribing.  N Engl J Med. 2010;363(21):1985-198821047217PubMedGoogle ScholarCrossref
3.
Donohue JM, Morden NE, Gellad WF,  et al.  Sources of regional variation in Medicare Part D drug spending.  N Engl J Med. 2012;366(6):530-53822316446PubMedGoogle ScholarCrossref
4.
Shah ND, Montori VM, Krumholz HM, Tu K, Alexander GC, Jackevicius CA. Responding to an FDA warning—geographic variation in the use of rosiglitazone.  N Engl J Med. 2010;363(22):2081-208421083379PubMedGoogle ScholarCrossref
5.
Gibson TB, Landrum MB, Batata A, Fendrick AM, Wang S, Chernew M. Regional variation in medication adherence.  Forum Health Econ Policy. 2011;14(2):article 8Google Scholar
6.
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%.  BMJ. 2003;326(7404):141912829553PubMedGoogle ScholarCrossref
7.
Jessup M, Abraham WT, Casey DE,  et al.  2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.  Circulation. 2009;119(14):1977-201619324967PubMedGoogle ScholarCrossref
8.
Choudhry NK, Shrank WH, Levin RL,  et al.  Measuring concurrent adherence to multiple related medications.  Am J Manag Care. 2009;15(7):457-46419589013PubMedGoogle Scholar
9.
Zhang Y, Baik SH, Fendrick AM, Baicker K. Comparing local and regional variation in health care spending.  N Engl J Med. 2012;367(18):1724-173123113483PubMedGoogle ScholarCrossref
Research Letter
Mar 25, 2013

Variation in Medication Adherence in Heart Failure

Author Affiliations

Author Affiliations: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zhang and Mr Wu); Department of Internal Medicine, School of Medicine, and the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Dr Fendrick); and Department of Health Policy & Management, Harvard School of Public Health, Boston, Massachusetts (Dr Baicker).

JAMA Intern Med. 2013;173(6):468-470. doi:10.1001/jamainternmed.2013.2509

Although recent studies have demonstrated geographic variation in pharmaceutical use and spending,1-4 regional variation in medication adherence in Medicare has not been explored.5 Medication adherence is a critical quality measure and is especially important for Medicare beneficiaries with heart failure (HF), a common condition in which medications can save lives and reduce downstream costs.6 We used 2007-2009 national Part D data for a 5% random sample of Medicare beneficiaries to study regional variation in HF medication adherence.

Our selection criteria included the following: (1) being 18 years or older; (2) having at least 1 inpatient or 2 (nonlaboratory) outpatient claims between January 1, 2007, and December 31, 2009, with selected International Classification of Diseases, Ninth Revision (ICD-9) codes indicating HF on primary, secondary, or third diagnosis; (3) being on at least 1 drug regimen from 1 of 3 therapeutic classes: β-blockers, angiotensin-converting enzymes inhibitors (ACEs) or angiotensin receptor antagonists (ARBs), and/or diuretics7; and (4) being continuously enrolled in Medicare Parts A, B, and D during the follow-up period. The follow-up period was 1 year after the first prescription drug of interest was filled, censored at the end of the study period (December 31, 2009), or death. The resulting 178 102 beneficiaries were assigned to 306 Dartmouth hospital referral regions (HRRs) based on their zip code of residence.

×