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. 2019 Nov 15;14(11):e0225390.
doi: 10.1371/journal.pone.0225390. eCollection 2019.

Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands

Sofa D Alfian  1   2 , Petra Denig  3 , André Coelho  4 , Eelko Hak  1
Affiliations
Free PMC article

Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands

Sofa D Alfian et al. PLoS One. .
Free PMC article

Abstract

Background: Adherence to antihypertensive drugs in patients with diabetes is important. To support adherence, attention should be paid to the dynamic process of implementation, persistence and reinitiation of these drugs. We assessed non-adherence, non-persistence and reinitiation patterns for antihypertensive drugs in patients on oral diabetes drugs and identified pharmacy-based predictors of these processes.

Methods: We conducted a cohort study in patients on oral diabetes drugs who initiated antihypertensive drugs between 1995-2015, as registered in the IADB.nl pharmacy database. Non-adherence was defined as a medication possession ratio < 80% and non-persistence as a gap > 180 days. We defined reinitiation as the dispensing of an antihypertensive drug within one year following discontinuation. We provide descriptive statistics for different time periods and applied logistic and Cox regressions to assess associations with sociodemographic and drug-related factors.

Results: Of 6,669 initiators, non-adherence rates in persistent patients decreased from 11.0% in the first year to 8.5% and 7.7% in the second and third years, respectively. Non-persistence rates decreased from 18.0% in the first year to 3.7% and 2.9% in the second and third years, respectively. Of the 1,201 patients who discontinued in the first year, 22.0% reinitiated treatment within one year. Non-adherence and non-persistence rates were lower in the more recent time period. Predictors of non-adherence were secondary prevention (OR: 1.45; 95% CI: 1.10-1.93) and diuretics as initial drug class (OR: 1.37; 95% CI: 1.08-1.74). Predictors of non-persistence were female gender (HR: 1.18; 95% CI: 1.05-1.32), older age (HR: 1.33; 95% CI: 1.08-1.63) and diuretics, beta-blocking agents or calcium channel blockers as initial drug class. Longer duration of persistence was a predictor of reinitiation.

Conclusions: Adherence to antihypertensive drugs in patients on oral diabetes drugs has improved over time. The first year after initiation is the most crucial with regard to non-adherence and non-persistence, and the risk groups are different for both processes. Early non-persistence is a risk factor for not reinitiating treatment.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of numbers of non-adherent and non-persistent patients and those who reinitiated antihypertensive drugs over three years.
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SDA is supported by a scholarship from Indonesia Endowment Fund for Education (LPDP no: PRJ-2361/LPDP/2015). This funding body did not have any role in designing the study, in analyzing and interpreting the data, in writing this article, and in deciding to submit it for publication.