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Racial differences in medication compliance and healthcare utilization among hypertensive Medicaid recipients: fixed-dose vs free-combination treatment.
Ethn Dis. 2008 Spring; 18(2):204-9.ED

Abstract

OBJECTIVE

To assess compliance with antihypertensive therapy and healthcare utilization among African American and White Medicaid recipients who are receiving fixed-dose combination amlodipine besylate/benazepril HCl or a dihydropyridine calcium channel blocker plus an angiotensin-converting enzyme inhibitor prescribed as separate agents (free-combination).

DESIGN

Longitudinal, retrospective, cohort analysis of South Carolina Medicaid claims for the years 1997 through 2002. Followup was 12 months from the index date, defined as the first prescription dispensing date for a study drug.

SETTING AND PARTICIPANTS

South Carolina Medicaid beneficiaries receiving fixed-dose (n=3363) and free-combination (n=713) therapy, including 3016 African Americans and 1060 White patients.

MAIN OUTCOME MEASURES

Compliance was defined as the total days' supply of drug (excluding last prescription fill) divided by the length of followup; healthcare utilization included cost and number of claims associated with ambulatory services, hospital care, and prescription drugs.

RESULTS

The cohort (N=4076) was 74.0% African American; mean age was 62.2 years. Compliance was significantly greater in patients who received fixed-dose therapy than in those who received free-combination therapy (58.6% vs 48.1%; P<.05). The average total cost of care was lower for the fixed-dose group ($4605) than for the free-combination group ($8531). African Americans and Whites were equally likely to receive the fixed-dose combination. However, compliance was lower among African American patients than among White patients (55% vs 61% respectively; P<.05). Costs and claims for ambulatory and hospital services were higher for African American patients, whereas drug costs and claims were higher for White patients.

CONCLUSION

Fixed-dose amlodipine besylate/benazepril HCl was associated with higher compliance rates than was free-combination therapy, independent of race. Lower compliance rates among African American patients may have contributed to the higher healthcare resource use and costs observed. Efforts to enhance medication compliance tailored to African Americans may improve outcomes and reduce costs in this high-risk population.

Authors+Show Affiliations

College of Pharmacy, University of South Carolina, Columbia, South Carolina 29208, USA. Dickson@cop.sc.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18507275

Citation

Dickson, Michael, and Craig A. Plauschinat. "Racial Differences in Medication Compliance and Healthcare Utilization Among Hypertensive Medicaid Recipients: Fixed-dose Vs Free-combination Treatment." Ethnicity & Disease, vol. 18, no. 2, 2008, pp. 204-9.
Dickson M, Plauschinat CA. Racial differences in medication compliance and healthcare utilization among hypertensive Medicaid recipients: fixed-dose vs free-combination treatment. Ethn Dis. 2008;18(2):204-9.
Dickson, M., & Plauschinat, C. A. (2008). Racial differences in medication compliance and healthcare utilization among hypertensive Medicaid recipients: fixed-dose vs free-combination treatment. Ethnicity & Disease, 18(2), 204-9.
Dickson M, Plauschinat CA. Racial Differences in Medication Compliance and Healthcare Utilization Among Hypertensive Medicaid Recipients: Fixed-dose Vs Free-combination Treatment. Ethn Dis. 2008;18(2):204-9. PubMed PMID: 18507275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial differences in medication compliance and healthcare utilization among hypertensive Medicaid recipients: fixed-dose vs free-combination treatment. AU - Dickson,Michael, AU - Plauschinat,Craig A, PY - 2008/5/30/pubmed PY - 2008/7/25/medline PY - 2008/5/30/entrez SP - 204 EP - 9 JF - Ethnicity & disease JO - Ethn Dis VL - 18 IS - 2 N2 - OBJECTIVE: To assess compliance with antihypertensive therapy and healthcare utilization among African American and White Medicaid recipients who are receiving fixed-dose combination amlodipine besylate/benazepril HCl or a dihydropyridine calcium channel blocker plus an angiotensin-converting enzyme inhibitor prescribed as separate agents (free-combination). DESIGN: Longitudinal, retrospective, cohort analysis of South Carolina Medicaid claims for the years 1997 through 2002. Followup was 12 months from the index date, defined as the first prescription dispensing date for a study drug. SETTING AND PARTICIPANTS: South Carolina Medicaid beneficiaries receiving fixed-dose (n=3363) and free-combination (n=713) therapy, including 3016 African Americans and 1060 White patients. MAIN OUTCOME MEASURES: Compliance was defined as the total days' supply of drug (excluding last prescription fill) divided by the length of followup; healthcare utilization included cost and number of claims associated with ambulatory services, hospital care, and prescription drugs. RESULTS: The cohort (N=4076) was 74.0% African American; mean age was 62.2 years. Compliance was significantly greater in patients who received fixed-dose therapy than in those who received free-combination therapy (58.6% vs 48.1%; P<.05). The average total cost of care was lower for the fixed-dose group ($4605) than for the free-combination group ($8531). African Americans and Whites were equally likely to receive the fixed-dose combination. However, compliance was lower among African American patients than among White patients (55% vs 61% respectively; P<.05). Costs and claims for ambulatory and hospital services were higher for African American patients, whereas drug costs and claims were higher for White patients. CONCLUSION: Fixed-dose amlodipine besylate/benazepril HCl was associated with higher compliance rates than was free-combination therapy, independent of race. Lower compliance rates among African American patients may have contributed to the higher healthcare resource use and costs observed. Efforts to enhance medication compliance tailored to African Americans may improve outcomes and reduce costs in this high-risk population. SN - 1049-510X UR - https://www.unboundmedicine.com/medline/citation/18507275/Racial_differences_in_medication_compliance_and_healthcare_utilization_among_hypertensive_Medicaid_recipients:_fixed_dose_vs_free_combination_treatment_ L2 - https://medlineplus.gov/highbloodpressure.html DB - PRIME DP - Unbound Medicine ER -