| 1. |
- Ekenberg, Marie, et al.
(författare)
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Socioeconomic factors associated with poor medication adherence in patients with type 2 diabetes
- 2024
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Ingår i: European Journal of Clinical Pharmacology. - : Springer. - 0031-6970 .- 1432-1041. ; 80, s. 53-63
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aims to determine initiation and persistence for patients with type 2 diabetes receiving their first prescription of an antidiabetic agent and the associations with socioeconomic factors.Methods: A cohort study including 8515 patients with type 2 diabetes who were prescribed their first antidiabetic medication between 2012 and 2019 in Uppsala, Sweden, was followed during 2 years. Medical records were linked to national registers on dispensed drugs and socioeconomic data. Adherence was assessed based on patients' medication claims within 30 days of prescription (initiation) and continued claims after 24 months (persistence). Multivariable logistic regression was used to determine the associations with the socioeconomic factors age, sex, living status, country of birth, education, occupation, and income.Results: Within 30 days, 92.4% of the patients claimed their first prescription, and 64.0% were still being dispensed the initially prescribed medication after 24 months. Unemployed patients had lower initiation rates, and women had lower persistence rates. Factors associated with both low initiation and persistence were low income, young or old age, birth outside Europe, and being prescribed other diabetes drugs than metformin monotherapy.Conclusion: Socioeconomic factors have different impact on the initiation of a new medication and the persistence to treatment in type 2 diabetes. It is important to acknowledge these differences to develop appropriate interventions to improve medication nonadherence.
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| 2. |
- Hasselstrom, J., et al.
(författare)
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The Swedish Primary Care Cardiovascular Database (SPCCD): 74 751 hypertensive primary care patients
- 2014
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 23:2, s. 116-125
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe the Swedish Primary Care Cardiovascular Database, SPCCD. Design. Longitudinal data from electronic medical records, linked to national registers. Setting. 48 primary healthcare centres in urban (south-western Stockholm) and rural (Skaraborg) regions in Sweden. Subjects. Patients diagnosed with hypertension 2001-2008. Main outcome measures. Blood pressure (BP) and impact of retrieval of data on BP levels, clinical characteristics, co-morbidity and pharmacological treatment. Results. The SPCCD contains 74 751 individuals, 56% women. Completeness of data ranged from >99% for drug prescriptions to 34% for smoking habits. BP was recorded in 98% of patients during 2001-2008 and in 63% in 2008. Mean BP based on the last recorded value in 2008 was 142 +/- 17/80 +/- 13 mmHg. Digit preference in BP measurements differed between the two regions, p < 0.001. Antihypertensive drugs were prescribed in primary healthcare to 88% of the patients in 2008; however, when all prescribers were included 96% purchased their drugs. Cardiovascular co-morbidity and diabetes mellitus were present in 28% and 22%, respectively. Conclusion. This large and representative database shows that there is room for improvement of BP control in Sweden. The SPCCD will provide a rich source for further research of hypertension and its complications.
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| 3. |
- Holmqvist, Lina, et al.
(författare)
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Drug adherence in treatment resistant and in controlled hypertension - Results from the Swedish Primary Care Cardiovascular Database (SPCCD)
- 2018
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569 .- 1099-1557. ; 27:3, s. 315-321
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To assess drug adherence in patients treated with 3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Methods Patients with hypertension, without cardiovascular comorbidity, aged >30years treated with 3 antihypertensive drug classes were followed for 2years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level80% were included. Results We found 5846 patients treated 3 antihypertensive drug classes, 3508 with TRH (blood pressure140/90), and 2338 with controlled blood pressure (<140/90mmHg). TRH patients were older (69.1 vs 65.8years, P<.0001) but had less diabetes (28.5 vs 31.7%, P<.009) compared with patients with controlled blood pressure. The proportion of patients with PDC80% declined with 11% during the first year in both groups. Having diabetes was associated with staying adherent at 1year (RR 0.82; 95% CI, 0.68-0.98) whilst being born outside Europe was associated with nonadherence at one and (RR 2.05; 95% CI, 1.49-2.82). ConclusionsPatients with multiple antihypertensive drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment.
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| 4. |
- Malkon, Salpe, et al.
(författare)
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A Qualitative Study on Patients' Views on Hypertension and Antihypertensive Medications
- 2023
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Ingår i: Patient Preference and Adherence. - : Dove Medical Press. - 1177-889X. ; 17, s. 3331-3339
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Few studies explored what patients initiated on blood pressure medication in primary care think about their disease and their medications. The aim of this study was to gain an understanding of hypertensive patients’ views on and experiences of hypertension and the use of antihypertensive medications.Methods: A qualitative study based on open-ended questions from a survey on medication adherence, which captured treated hypertensive patients’ perspective on their condition and treatment. Data were collected for 219 patients on antihypertensive medication, ≥ 30 years old, who consulted 25 primary health care centers in Stockholm, Sweden, during 2016. Thematic analysis with both inductive and deductive approach was applied.Results: We identified 21 codes from the data and grouped them under the World Health Organization’s five dimensions of adherence: condition-, therapy-, health care team and system-, patient-, and socioeconomic-related factors. The analyses revealed that many patients with hypertension have limited knowledge of their disease, are afraid of drug side effects and experience various issues in primary health care that may negatively impact adherence, including short doctor appointments, prescribing without communication and room for improvement in individualization of therapy and a person-centered approach.Conclusion: Many patients with hypertension have limited understanding of their hypertension and fear of adverse events from their antihypertensive medications. There is also room for improvement in how the patients are managed in primary health care. Interventions should focus on these issues to promote a better blood pressure target achievement.
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| 5. |
- Qvarnström, Miriam, et al.
(författare)
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Antihypertensive treatment and control in a large primary care population of 21 167 patients
- 2011
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Ingår i: Journal of Human Hypertension. - London, UK : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 25:8, s. 484-491
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Tidskriftsartikel (refereegranskat)abstract
- The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure <140/90mmHg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary health-care centres, with a combined registered population of 330 000 subjects. We included all patients >= 30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n = 21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure <140/90mmHg. The number of prescribed drugs increased with age, except among the oldest (>= 90 years). Only 29% of patients given monotherapy had a blood pressure <140/90mmHg. Women more often received diuretics (52 vs 42%), and less often angiotensin-converting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. beta-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control. Journal of Human Hypertension (2011) 25, 484-491; doi: 10.1038/jhh.2010.86; published online 19 August 2010
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| 6. |
- Qvarnström, Miriam, et al.
(författare)
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Medication persistence to antihypertensive drug treatment : a cross-sectional study of attitudes towards hypertension and medication in persistent and non-persistent patients
- 2019
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 28:5, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To study the differences in attitudes towards hypertension and drug treatment between patients persistent and non-persistent to antihypertensive drug treatment.Materials and methods: Cross-sectional study on patients with hypertension treated at 25 primary healthcare centres in Stockholm, Sweden. Questionnaires were sent to the patients 3-12 months after initiation of antihypertensive drug treatment. Persistent medication users, defined as patients with less than 30 days without tablet supply between prescription refills, were compared with non-persistent users by scores from Likert scales: Brief-Illness Perception Questionnaire (Brief IPQ, 0-10) and Beliefs about Medicines Questionnaire (BMQ General, 4-20 and BMQ Specific, 5-25).Results: A total of 711 patients were included in the final analyses (mean age: 62 years; 50% women), of whom 609 (86%) were classified as persistent and 102 (14%) as non-persistent by analyses of their filled prescriptions. Likert scales from the Brief-IPQ showed (all p<0.02) that persistent patients believed that hypertension was a chronic condition (median 6 vs. 4), that hypertension had less consequences on their life (median 2 vs. 3) and that they can prevent cardiovascular disease by taking antihypertensive treatment (median 7 vs. 5). Likert scales from the BMQ General showed (all p<0.02) that persistent patients believed that there are potential benefits from taking the treatment (median 16 vs. 16), and they did not believe that the doctors put too much trust in drugs (median 12 vs. 13). Further, results from the BMQ Specific showed that they believed that the antihypertensive drugs are necessary for them in order to maintain or improve their own health (median 17 vs. 16).Conclusions: Primary healthcare providers should further emphasize the chronicity of hypertension diagnosis and the benefits of treatment, to improve the patients' medication persistence to antihypertensive treatment.
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| 7. |
- Qvarnström, Miriam, et al.
(författare)
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Persistence to antihypertensive drug classes : A cohort study using the Swedish Primary Care Cardiovascular Database (SPCCD)
- 2016
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Ingår i: Medicine. - 0025-7974 .- 1536-5964. ; 95:40
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study persistence to, and switching between, antihypertensive drug classes and to determine factors associated with poor persistence.This was an observational cohort study. The Swedish Primary Care Cardiovascular Database includes data from medical records, socioeconomic data, filled prescriptions, and hospitalizations from national registries for 75,000 patients with hypertension. Patients included in the study were initiated on antihypertensive drug treatment in primary healthcare in 2006 to 2007. We defined class persistence as the proportion remaining on the initial drug class, including 30 days of gap. Patients with a filled prescription of another antihypertensive drug class after discontinuation of the initial drug, including 30 days of gap, were classified as switchers. Persistence to the various drug classes were compared with that for diuretics.We identified 4997 patients (mean age 60 ± 12 years in men and 63 ± 13 years in women). Out of these, 95 (2%) filled their first prescription for fixed combination therapy and 4902 (98%) for monotherapy, including angiotensin converting enzyme inhibitors (37%), angiotensin receptor blockers (4%), beta blockers (21%), calcium channel blockers (8%), and diuretics (28%). Persistence to the initial drug class was 57% after 1 year and 43% after 2 years. There were no differences in persistence between diuretics and any of the other antihypertensive drug classes, after adjustment for confounders. Discontinuation (all adjusted) was more common in men (P = 0.004), younger patients (P < 0.001), those with mild systolic blood pressure elevation (P < 0.001), and patients born outside the Nordic countries (P < 0.001). Among 1295 patients who switched drug class after their first prescription, only 21% had a blood pressure recorded before the switch occurred; and out them 69% still had high blood pressures.In conclusion, there appears to be no difference in drug class persistence between diuretics and other major antihypertensive drug classes, when factors known to be associated with poor persistence are taken into account.
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| 8. |
- Qvarnström, Miriam
(författare)
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Persistence to antihypertensive drug treatment in Swedish primary care
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The efficacy of antihypertensive drug therapy is undisputed, but large surveys report that one in four patients reach a target blood pressure of <140/90 mm Hg. Although there are several explanations to this problem, poor medication adherence and persistence to drug treatment suggests as important contributors. We started with a cross-sectional study design, to describe drug prescription patterns and blood pressure control in 24 primary healthcare centers in southwestern part of Stockholm, Sweden. Electronic medical records of 21167 patients (≥30 years) with a diagnosis of hypertension and a consultation at one of the included primary health care centers in 2005-2006 were analyzed. A prescription of an antihypertensive drug were found in 89% of the patients, and the most common were the diuretics and beta blockers. One out of four primary care patients with hypertension had a target blood pressure <140/90 mm Hg with or without antihypertensive drug treatment. Medication persistence is considered an important factor to poor blood pressure control. Therefore, in the subsequent project, we used a cohort study design to measure persistence after two years of follow-up and analyzed factors associated with low therapy persistence, i.e. persistence to any antihypertensive drug class treatment. Using electronic medical records for patients with hypertension in 48 Swedish primary healthcare centers and data linkage to national registers on dispensed drugs, hospitalizations, outpatient hospital consultations, deaths, migration, and socioeconomy, we were able to identify 5225 patients initiated on antihypertensive drug treatment during 2006- 2007. Among patients with a dispensed first prescription, 65 % were persistent after the two years of follow-up. Factors associated with low therapy persistence to antihypertensive drug treatment were male sex, younger age, mild-to-moderate systolic blood pressure elevation, and birth outside of Sweden. After the assessment of therapy persistence, an important question remained, and that was to answer if there was a difference in persistence to the various antihypertensive drug classes? Again, we performed a cohort study with the same method described above, but analyzed each antihypertensive drug class in comparison to the diuretics. It appeared to be no difference in drug class persistence between diuretics and the other major antihypertensive drug classes. Predictors behind low class persistence were the same as for therapy persistence. Although register studies are of interest and of great value, they lack certain information. To get a broader picture of the medication persistence, we decided to perform a cross-sectional study and use questionnaires to ask the patients about their beliefs about medicines and the hypertension diagnosis. The questionnaires were linked with data on the patient’s filled prescription and the patients were categorized into persistent or non-persistent medication-users, to observe potential differences in the attitudes between the persistent and non-persistent patients. Out of the 69 primary healthcare centers questioned, 25 agreed to participate in the study. In January 2016, patients with a diagnosis of hypertension and a consultation at one of the 25 primary health care centers received a questionnaire 3-12 months after initiation of drug treatment. Out of the 1197 patients newly initiated antihypertensive drug treatment, 711 patients (59%) responded. Patients were classified as persistent (609, 86%) or non-persistent (102, 14%) to antihypertensive drug treatment by analyses of their filled prescriptions. Compared to non-persistent medication users, patients persistent to medication believed to a higher degree that the diagnosis of hypertension was chronic, that it had less consequence on their life, that they can prevent cardiovascular disease by taking antihypertensive drug treatment and that there is something positive about taking the pharmacological treatment.
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| 9. |
- Qvarnström, Miriam, et al.
(författare)
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Persistence to antihypertensive drug treatment in Swedish primary healthcare
- 2013
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 69:11, s. 1955-1964
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Tidskriftsartikel (refereegranskat)abstract
- To determine factors associated with low persistence in patients initiated on drug treatment for hypertension. Cohort study using medical records for patients with hypertension in 48 Swedish primary healthcare centres. Data were linked to national registers on dispensed drugs, hospitalizations, outpatient hospital consultations, deaths, migration, and socioeconomy. We identified 5225 patients (55 % women, mean age 61 years) initiated on antihypertensive drug treatment during 2006-2007. Persistence was measured for two years by the dispensed drugs. Patients with a gap of > 30 days between end of dispensed supply and the next dispensed prescription were classified as non-persistent. This was calculated by Kaplan-Meier analysis. Cox proportional hazard regression was used to estimate hazard ratios for discontinuation. Potential predictors included age, gender, blood pressure before initiation of therapy, cardiovascular comorbidity, educational level, country of birth, and income. Among patients with a dispensed first prescription, 26 % discontinued treatment during the first year, and a further 9 % discontinued during the second year. Discontinuation (all adjusted) was more common in men (P = 0.002) and in younger patients (30-49 years, P < 0.001). Systolic (P < 0.001) but not diastolic blood pressure was positively associated with persistence. Native-born Swedish citizens and patients born in the other Nordic countries had lower discontinuation rates than those born outside the Nordic countries (P < 0.001). Major determinants of discontinuation of antihypertensive drug treatment are male sex, young age, mild-to-moderate systolic blood pressure elevation, and birth outside of Sweden.
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