Evaluating Adherence to Concomitant Diabetes, Hypertension, and Hyperlipidemia Treatments and Cardiovascular Outcomes Among Elderly Patients Using Marginal Structural Modeling.

INTRODUCTION: Comorbid diabetes, hypertension, and hyperlipidemia is associated with an adverse effect on cardiovascular (CV) outcomes. Adherence to concurrent anti-diabetics, anti-hypertensives, and lipid-lowering therapies is essential to achieve therapeutic benefits. AIM: The objective was to evaluate the association between adherence to concomitant oral antidiabetics, statins, and RAS antagonists (triple therapy) and CV outcomes, among elderly patients using marginal structural modeling (MSM). METHODS: A retrospective study was conducted among patients on concurrent triple therapy from January 2016 until December 2019. Adherence to concurrent triple therapy was measured every 6 months using proportion of days covered (PDC) to determine the different adherence groups. CV outcomes were also measured every 6 months. A MSM controlling for baseline covariates and time-varying confounders affected by prior adherence was conducted to evaluate the association between adherence and CV outcomes. A sub-analysis was conducted among patients with prior CV events to evaluate the association between adherence to triple therapy and CV outcomes using MSMs. RESULTS: The final cohort comprised of 7433 patients. The MSM model revealed no significant associations between adherence to triple/double therapies and cardiovascular outcomes. For sub-analysis, 471 patients with a prior CV event were identified. Results of the sub-analysis revealed no significant associations between adherence to triple/double therapies and CV outcomes among patients with prior CV events. CONCLUSION: Future studies should evaluate the association with longer follow-up periods.

Strategies for implementing lipid-lowering therapy: pharmacy-based approach.

A multidisciplinary program was designed to improve patient outcomes after an acute coronary event. The primary objective of the program was that lipid-lowering therapy be prescribed at the time of discharge for acute myocardial infarction (AMI) and percutaneous transluminal coronary angioplasty (PTCA) patients. Secondary objectives for this program were (1) a baseline lipid panel within the first 24 hours of admission and (2) documentation of discharge counseling for lipid-lowering therapy in the patient medical record. Improvements were reported for all 3 objectives. For the primary indicator, lipid-lowering therapy prescribed at discharge, the baseline value increased from 40% to 72-81%. The percentage of patients with a lipid panel within 24 hours of admission improved from a baseline of 13% to 38-71%. Overall, 28-77% of patient records contained documentation of lipid-lowering medication counseling after initiation of the program. This information should provide the necessary benchmarking data to maintain competitiveness in the dynamic healthcare environment. Overall, this program provides high-quality, cost-effective health care for the patient with established coronary artery disease.

Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.