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Wide Clinic-Level Variation in Adherence to Oral Diabetes Medications in the VA

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ABSTRACT

BACKGROUND

While there has been extensive research into patient-specific predictors of medication adherence and patient-specific interventions to improve adherence, there has been little examination of variation in clinic-level medication adherence.

OBJECTIVE

We examined the clinic-level variation of oral hypoglycemic agent (OHA) medication adherence among patients with diabetes treated in the Department of Veterans Affairs (VA) primary care clinics. We hypothesized that there would be systematic variation in clinic-level adherence measures, and that adherence within organizationally-affiliated clinics, such as those sharing local management and support, would be more highly correlated than adherence between unaffiliated clinics.

DESIGN

Retrospective cohort study.

SETTING

VA hospital and VA community-based primary care clinics in the contiguous 48 states.

PATIENTS

444,418 patients with diabetes treated with OHAs and seen in 158 hospital-based clinics and 401 affiliated community primary care clinics during fiscal years 2006 and 2007.

MAIN MEASURES

Refill-based medication adherence to OHA.

KEY RESULTS

Adjusting for patient characteristics, the proportion of patients adherent to OHAs ranged from 57 % to 81 % across clinics. Adherence between organizationally affiliated clinics was high (Pearson Correlation = 0.82), and adherence between unaffiliated clinics was low (Pearson Correlation = 0.04).

CONCLUSION

The proportion of patients adherent to OHAs varied widely across VA primary care clinics. Clinic-level adherence was highly correlated to other clinics in the same organizational unit. Further research should identify which factors common to affiliated clinics influence medication adherence.

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Acknowledgements

This research was supported by an Investigator Initiated Research Award (IIR 07-068-2) from the Department of Veterans Affairs, Health Services Research and Development. Dr. Bryson was supported by VA Career Development Award 03-177. Dr. Jackson was supported for a portion of this project by a VA Career Development Award. Dr. Piette is a VA Senior Research Career Scientist; Dr. Maciejewski and Dr. Yano are VA Research Career Scientists. Dr. Wong was supported by VA Health Services Research and Development Postdoctoral Fellowship TPP 61-024. An earlier version of this manuscript was presented as a poster at the Society of General Internal Medicine 32nd Annual Meeting in Miami, FL in 2009. Dr. Bryson takes responsibility for the integrity of the data and the accuracy of the data analysis. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

All authors are federal employees for the Department of Veterans Affairs. Dr. Au has received consultation funds from Bosch Inc. and a grant from Gilead Sciences. Dr. Maciejewski has received consultation funds from Takeda Pharmaceuticals, Novartis and the Surgical Review Corporation. Dr. Maciejewski also owns stock in Amgen.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, WA, USA

    Chris L. Bryson MD, MS, David H. Au MD, MS, Mark Perkins PharmD, Edwin S. Wong PhD & Chuan-Fen Liu PhD

  2. Department of Medicine, University of Washington, Seattle, WA, USA

    Chris L. Bryson MD, MS, David H. Au MD, MS & Stephan D. Fihn MD, MPH

  3. Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA

    Matthew L. Maciejewski PhD & George L. Jackson PhD, MHA

  4. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Matthew L. Maciejewski PhD & George L. Jackson PhD, MHA

  5. Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    John D. Piette PhD

  6. Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA

    John D. Piette PhD

  7. Office of Analytics and Business Intelligence, Department of Veterans Affairs, University of Washington, Seattle, WA, USA

    Stephan D. Fihn MD, MPH

  8. Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA

    Edwin S. Wong PhD & Chuan-Fen Liu PhD

  9. Center for the Study of Healthcare Provider Behavior, Los Angeles VA, Los Angeles, CA, USA

    Elizabeth M. Yano PHD, MSPH

  10. Department of Health Services, University of California, Los Angeles, CA, USA

    Elizabeth M. Yano PHD, MSPH

  11. Health Services Research & Development, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA

    Chris L. Bryson MD, MS

Authors
  1. Chris L. Bryson MD, MS
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  2. David H. Au MD, MS
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  3. Matthew L. Maciejewski PhD
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  4. John D. Piette PhD
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  5. Stephan D. Fihn MD, MPH
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  6. George L. Jackson PhD, MHA
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  7. Mark Perkins PharmD
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  8. Edwin S. Wong PhD
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  9. Elizabeth M. Yano PHD, MSPH
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  10. Chuan-Fen Liu PhD
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Corresponding author

Correspondence to Chris L. Bryson MD, MS.

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Bryson, C.L., Au, D.H., Maciejewski, M.L. et al. Wide Clinic-Level Variation in Adherence to Oral Diabetes Medications in the VA. J GEN INTERN MED 28, 698–705 (2013). https://doi.org/10.1007/s11606-012-2331-y

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  • DOI: https://doi.org/10.1007/s11606-012-2331-y

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