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Wide clinic-level variation in adherence to oral diabetes medications in the VA.

Publication ,  Journal Article
Bryson, CL; Au, DH; Maciejewski, ML; Piette, JD; Fihn, SD; Jackson, GL; Perkins, M; Wong, ES; Yano, EM; Liu, C-F
Published in: J Gen Intern Med
May 2013

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.

Duke Scholars

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2013

Volume

28

Issue

5

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Primary Health Care
  • Outpatient Clinics, Hospital
  • Middle Aged
  • Medication Adherence
  • Male
  • Hypoglycemic Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bryson, C. L., Au, D. H., Maciejewski, M. L., Piette, J. D., Fihn, S. D., Jackson, G. L., … Liu, C.-F. (2013). Wide clinic-level variation in adherence to oral diabetes medications in the VA. J Gen Intern Med, 28(5), 698–705. https://doi.org/10.1007/s11606-012-2331-y
Bryson, Chris L., David H. Au, Matthew L. Maciejewski, John D. Piette, Stephan D. Fihn, George L. Jackson, Mark Perkins, Edwin S. Wong, Elizabeth M. Yano, and Chuan-Fen Liu. “Wide clinic-level variation in adherence to oral diabetes medications in the VA.J Gen Intern Med 28, no. 5 (May 2013): 698–705. https://doi.org/10.1007/s11606-012-2331-y.
Bryson CL, Au DH, Maciejewski ML, Piette JD, Fihn SD, Jackson GL, et al. Wide clinic-level variation in adherence to oral diabetes medications in the VA. J Gen Intern Med. 2013 May;28(5):698–705.
Bryson, Chris L., et al. “Wide clinic-level variation in adherence to oral diabetes medications in the VA.J Gen Intern Med, vol. 28, no. 5, May 2013, pp. 698–705. Pubmed, doi:10.1007/s11606-012-2331-y.
Bryson CL, Au DH, Maciejewski ML, Piette JD, Fihn SD, Jackson GL, Perkins M, Wong ES, Yano EM, Liu C-F. Wide clinic-level variation in adherence to oral diabetes medications in the VA. J Gen Intern Med. 2013 May;28(5):698–705.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2013

Volume

28

Issue

5

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Primary Health Care
  • Outpatient Clinics, Hospital
  • Middle Aged
  • Medication Adherence
  • Male
  • Hypoglycemic Agents