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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results
1 to 25 of 27 Research Studies Displayed
Oikonomidi T, Ravaud P, Cosson E
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
Investigators sought to identify the minimum effectiveness patients report they require to adopt 36 different remote digital monitoring (RDM) scenarios. Adults with type 1 or type 2 diabetes living in 30 countries assessed three randomly selected scenarios from a total of 36 that described different combinations of digital monitoring tools. The investigators found that patients required greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. They recommended that patient monitoring devices be designed to be minimally intrusive.
AHRQ-authored.
Citation:
Oikonomidi T, Ravaud P, Cosson E .
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
JAMA Netw Open 2021 Jan;4(1):e2033115. doi: 10.1001/jamanetworkopen.2020.33115..
Keywords:
Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Care Management, Patient Self-Management, Patient Adherence/Compliance
Despins LA, Wakefield BJ
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
The purpose of this study was to describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behavior. One-on-one interviews with adults diagnosed with type 2 diabetes mellitus were used. Results showed that individuals used self-monitored glucose values and/or HbA1C values to evaluate glucose control. Recommendations included having nurses assess sense-making processes in self-management decisions and providing periodic refresher diabetes education for individuals with type 2 diabetes mellitus.
AHRQ-funded; HS022140.
Citation:
Despins LA, Wakefield BJ .
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
J Clin Nurs 2020 Jul;29(13-14):2572-88. doi: 10.1111/jocn.15280..
Keywords:
Patient Self-Management, Diabetes, Chronic Conditions, Patient Adherence/Compliance, Decision Making
Flory JH, Mushlin AI
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
This paper studied whether persistence and adherence to initial release (IR) metformin was at the same levels as extended release (ER) metform for adults with type 2 diabetes. A study was conducted using merged de-identified claims data from commercial insurance carriers in the US from 2012 to 2016. The cohort used was identified as patients aged 18 years or older who filled an initial 30-day prescription for metformin monotherapy with a baseline type 2 diabetes diagnosis, at least 1 year of baseline and follow-up data, and no prior antidiabetes drug use. “Persistence” was defined as at least one metformin prescription claim during the 6-12 month window after the initial prescription. “Adherence” was defined as the percentage of days for which the patient had filled sufficient prescriptions to be taking it “as prescribed”. The final study population was 81,406 patients, with 78% having commercial insurance, 19% Medicare Advantage, and 2.5% were dual-eligible for Medicare and Medicare. Persistence was slightly higher for ER metformin than for IR metformin, as was adherence and adequate adherence (80% or more). Despite the slightly higher cost, initial use of ER metformin was associated with better adherence.
AHRQ-funded; HS023898.
Citation:
Flory JH, Mushlin AI .
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
Diabetes Care 2020 Jun;43(6):e66-e67. doi: 10.2337/dc19-2426..
Keywords:
Diabetes, Chronic Conditions, Healthcare Costs, Medication, Patient Adherence/Compliance
Aronson BD, Sittner KJ, Walls ML
The mediating role of diabetes distress and depressive symptoms in type 2 diabetes medication adherence gender differences.
Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes.
AHRQ-funded; HS024180.
Citation:
Aronson BD, Sittner KJ, Walls ML .
The mediating role of diabetes distress and depressive symptoms in type 2 diabetes medication adherence gender differences.
Health Educ Behav 2020 Jun;47(3):474-82. doi: 10.1177/1090198119885416..
Keywords:
Medication, Diabetes, Patient Adherence/Compliance, Chronic Conditions, Sex Factors
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation:
Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords:
Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Flory JH, Keating S, Guelce D
Overcoming barriers to the use of metformin: patient and provider perspectives.
Researcher undertook a qualitative study of barriers to metformin use from the patient and provider perspective. A purposive sampling of patients and providers in New York State were interviewed and 1259 charts manually reviewed. The researchers found that, although metformin is positively viewed by patients and providers, gastrointestinal side effects are a barrier to its use. They recommended clinical trial research on optimal dose, formulation, and counseling for new users.
AHRQ-funded; HS023898.
Citation:
Flory JH, Keating S, Guelce D .
Overcoming barriers to the use of metformin: patient and provider perspectives.
Patient Prefer Adherence 2019 Aug 22;13:1433-41. doi: 10.2147/ppa.S211614..
Keywords:
Medication, Diabetes, Patient Adherence/Compliance, Patient Experience
Kang H, Lobo JM, Kim S
Cost-related medication non-adherence among U.S. adults with diabetes.
The purpose of this study is to examine factors that affect cost-related medication non-adherence (CRN), defined as taking medication less than as prescribed because of cost, among adults with diabetes and to determine their relative contribution in explaining CRN. Among other results, the study found that Insulin users had 1.24 times higher risk of CRN compared to those not on insulin.
AHRQ-funded; HS018542.
Citation:
Kang H, Lobo JM, Kim S .
Cost-related medication non-adherence among U.S. adults with diabetes.
Diabetes Res Clin Pract 2018 Sep;143:24-33. doi: 10.1016/j.diabres.2018.06.016..
Keywords:
Diabetes, Healthcare Costs, Medication, Patient Adherence/Compliance
Flory JH, Keating SJ, Siscovick D
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
Non-persistence may be a significant barrier to the use of metformin. The objective of this study was to assess reasons for metformin non-persistence, and whether initial metformin dosing or use of extended release (ER) formulations affect persistence to metformin therapy. The investigators concluded that their data supported the routine prescribing of low starting doses of metformin as a tool to improve persistence.
AHRQ-funded; HS023898.
Citation:
Flory JH, Keating SJ, Siscovick D .
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
BMJ Open 2018 Jul 23;8(7):e021505. doi: 10.1136/bmjopen-2018-021505..
Keywords:
Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Adherence/Compliance, Outcomes, Patient-Centered Outcomes Research, Risk
Karter AJ, Parker MM, Solomon MD
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
This study estimated the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index.
AHRQ-funded; HS022408.
Citation:
Karter AJ, Parker MM, Solomon MD .
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2018 Apr;53(2):1227-47. doi: 10.1111/1475-6773.12700.
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Keywords:
Diabetes, Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Aysola J, Tahirovic E, Troxel AB
A randomized controlled trial of opt-in versus opt-out enrollment into a diabetes behavioral intervention.
This study compared an opt-out default recruitment strategy with a conventional opt-in strategy for enrollment in behavioral intervention for poorly controlled diabetic patients. The patients were put in a randomized controlled trial at the University of Pennsylvania-associated primary care practices. Enrollment rates were improved for the opt-out default patients.
AHRQ-funded; HS021706.
Citation:
Aysola J, Tahirovic E, Troxel AB .
A randomized controlled trial of opt-in versus opt-out enrollment into a diabetes behavioral intervention.
Am J Health Promot 2018 Mar;32(3):745-52. doi: 10.1177/0890117116671673..
Keywords:
Behavioral Health, Diabetes, Lifestyle Changes, Patient Adherence/Compliance
Taira DA, Seto BK, Davis JW
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
This study examined racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities. After adjustment for other factors, Filipinos, Native Hawaiians, and people of other race were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese.
AHRQ-funded; HS023185.
Citation:
Taira DA, Seto BK, Davis JW .
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
J Pharm Health Serv Res 2017 Dec;8(4):247-53. doi: 10.1111/jphs.12193.
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Keywords:
Diabetes, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare, Racial / Ethnic Minorities
Flory J, Gerhard T, Stempniewicz N
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. The authors note that the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. The authors also note that the physicians should be aware of potentially significant challenges concerning adherence to newer agents.
AHRQ-funded; HS023898.
Citation:
Flory J, Gerhard T, Stempniewicz N .
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
Diabetes Obes Metab 2017 Aug;19(8):1184-87. doi: 10.1111/dom.12931..
Keywords:
Diabetes, Electronic Health Records (EHRs), Patient Adherence/Compliance, Practice Patterns, Medication
Maciejewski ML, Hammill BG, Bayliss EA
Prescriber continuity and disease control of older adults.
The objective of this study was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications. It concluded that multiple prescribers were associated with worse disease control, possibly because patients with more severe diabetes or dyslipidemia have multiple prescribers or because care fragmentation is associated with worse disease control.
AHRQ-funded; HS023085.
Citation:
Maciejewski ML, Hammill BG, Bayliss EA .
Prescriber continuity and disease control of older adults.
Med Care 2017 Apr;55(4):405-10. doi: 10.1097/mlr.0000000000000658.
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Keywords:
Elderly, Medication, Diabetes, Patient Adherence/Compliance, Healthcare Delivery
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
AHRQ-funded; HS022982.
Citation:
Yeung K, Basu A, Marcum ZA .
Impact of a value-based formulary in three chronic disease cohorts.
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Keywords:
Chronic Conditions, Diabetes, Health Insurance, Hypertension, Medication, Patient Adherence/Compliance, Payment, Value
Heerman WJ, Wallston KA, Osborn CY
Food insecurity is associated with diabetes self-care behaviours and glycaemic control.
The objective of the study was to examine the association between food insecurity, diabetes self-care and glycaemic control. It concluded that there was a high rate of food insecurity in a sample of patients with Type 2 diabetes who were of low socio-economic status. Food insecurity was associated with less adherence to recommended self-care behaviours and worse glycaemic control.
AHRQ-funded; HS022990.
Citation:
Heerman WJ, Wallston KA, Osborn CY .
Food insecurity is associated with diabetes self-care behaviours and glycaemic control.
Diabet Med 2016 Jun;33(6):844-50. doi: 10.1111/dme.12896.
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Keywords:
Diabetes, Nutrition, Patient Adherence/Compliance, Patient-Centered Outcomes Research, Patient Self-Management
Osborn CY, Mayberry LS, Kim JM
Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults.
The authors sought to identify which behaviors are most important for HbA1c among low-socioeconomic status patients with type 2 diabetes mellitus. They found that only medication adherence was significantly associated with lower HbA1c after adjusting for the other self-care behaviours and further adjusting for demographic and diabetes characteristics. They suggested that focused efforts to improve medication adherence among low-socioeconomic status patient populations may improve glycemic control.
AHRQ-funded; HS022990.
Citation:
Osborn CY, Mayberry LS, Kim JM .
Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults.
J Clin Pharm Ther 2016 Jun;41(3):256-9. doi: 10.1111/jcpt.12360.
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Keywords:
Diabetes, Low-Income, Medication, Patient Adherence/Compliance, Patient-Centered Outcomes Research
Lyles CR, Seligman HK, Parker MM
Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: The Diabetes Study of Northern California (DISTANCE).
The researchers examined self-reported financial strain in relation to pharmacy utilization adherence data. Their analysis of survey, administrative, and electronic medical data from Kaiser Permanente Northern California found that 8 percent and 9 percent reported general and medication-specific financial strain. In adjusted models, general strain was significantly associated with primary nonadherence and refilling late and medication-specific strain was ssociated with primary nonadherence.
AHRQ-funded; HS022408.
Citation:
Lyles CR, Seligman HK, Parker MM .
Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: The Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2016 Apr;51(2):610-24. doi: 10.1111/1475-6773.12346.
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Keywords:
Diabetes, Medication, Patient Adherence/Compliance, Healthcare Costs, Healthcare Delivery
Lafata JE, Karter AJ, O'Connor PJ
Medication adherence does not explain black-white differences in cardiometabolic risk factor control among insured patients with diabetes.
The researchers examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. They found poorer medication adherence among black patients than white patients. They concluded that medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.
AHRQ-funded; HS019859.
Citation:
Lafata JE, Karter AJ, O'Connor PJ .
Medication adherence does not explain black-white differences in cardiometabolic risk factor control among insured patients with diabetes.
J Gen Intern Med 2016 Feb;31(2):188-95. doi: 10.1007/s11606-015-3486-0.
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Keywords:
Cardiovascular Conditions, Diabetes, Medication, Patient Adherence/Compliance, Racial / Ethnic Minorities
Gatwood J, Balkrishnan R, Erickson SR
The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: a randomized pilot study.
The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes. It found that declines in medication adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period.
AHRQ-funded; HS021976.
Citation:
Gatwood J, Balkrishnan R, Erickson SR .
The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: a randomized pilot study.
Res Social Adm Pharm 2016 Jan-Feb;12(1):130-40. doi: 10.1016/j.sapharm.2015.04.007.
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Keywords:
Diabetes, Medication, Patient Adherence/Compliance, Health Information Technology (HIT), Clinician-Patient Communication
Stuart BC, Davidoff AJ, Erten MZ
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
The researchers sought to determine whether a new cancer diagnosis is associated with changes in medication adherence among Medicare beneficiaries with diabetes. They concluded that cancer diagnosis among patients with diabetes reduced adherence with evidence-based medications, particularly if patients’ life expectancy was short.
Citation:
Stuart BC, Davidoff AJ, Erten MZ .
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
J Oncol Pract 2015 Nov;11(6):429-34. doi: 10.1200/jop.2014.003046..
Keywords:
Medication, Medicare, Cancer, Diabetes, Patient Adherence/Compliance
Miller GE, Sarpong EM, Hill SC
Does increased adherence to medications change health care financial burdens for adults with diabetes?
The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities. The researchers found that the mean simulated additional out-of-pocket drug costs of achieving adherence were $310 for uninsured adults treated for diabetes. These additional drug costs would increase the percentage of uninsured adults with financial burden.
AHRQ-authored.
Citation:
Miller GE, Sarpong EM, Hill SC .
Does increased adherence to medications change health care financial burdens for adults with diabetes?
J Diabetes 2015 Nov;7(6):872-80. doi: 10.1111/1753-0407.12292..
Keywords:
Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Diabetes, Patient Adherence/Compliance, Medication
Ratanawongsa N, Karter AJ, Quan J
Reach and validity of an objective medication adherence measure among safety net health plan members with diabetes: a cross-sectional study.
The objective of this study was to evaluate the performance of continuous medication gap (CMG) for diverse, low-income managed care members with diabetes. It concluded that CMG demonstrated acceptable inclusiveness and validity in a diverse, low-income safety net population, comparable with its performance in studies among other insured populations.
AHRQ-funded; HS020684; HS022561; HS017261.
Citation:
Ratanawongsa N, Karter AJ, Quan J .
Reach and validity of an objective medication adherence measure among safety net health plan members with diabetes: a cross-sectional study.
J Manag Care Spec Pharm 2015 Aug;21(8):688-98. doi: 10.18553/jmcp.2015.21.8.688..
Keywords:
Diabetes, Patient Adherence/Compliance, Patient Self-Management, Medication, Low-Income
Schmittdiel JA, Nichols GA, Dyer W
Health care system-level factors associated with performance on Medicare STAR adherence metrics in a large, integrated delivery system.
The researchers examined the association of Medicare STAR adherence metrics with system-wide factors for patients with diabetes. They found that the strongest predictor of achieving STAR-defined medication adherence for patients with diabetes was a greater days’ supply of medications. Other important factors were use of a mail order pharmacy, lower copayments and lower annual individual out-of-pocket maximums.
AHRQ-funded; HS019859
Citation:
Schmittdiel JA, Nichols GA, Dyer W .
Health care system-level factors associated with performance on Medicare STAR adherence metrics in a large, integrated delivery system.
Med Care. 2015 Apr;53(4):332-7. doi: 10.1097/mlr.0000000000000328..
Keywords:
Medicare, Diabetes, Patient Adherence/Compliance, Quality Measures
Mayberry LS, Egede LE, Wagner JA
Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support.
The researchers tested the moderation hypotheses that the associations between stressors/depressive symptoms and nonadherence would be stronger in the context of more obstructive family behaviors (exacerbating hypothesis) and weaker in the context of more supportive family behaviors (buffering hypothesis). They found that stressors and nonadherence were only associated at higher levels of obstructive family behaviors. Similarly, depressive symptoms and nonadherence were only associated at higher levels of obstructive family behaviors.
AHRQ-funded; HS022990.
Citation:
Mayberry LS, Egede LE, Wagner JA .
Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support.
J Behav Med 2015 Apr;38(2):363-71. doi: 10.1007/s10865-014-9611-4..
Keywords:
Diabetes, Medication, Patient Adherence/Compliance, Depression, Stress
Schmittdiel J, Raebel M, Dyer W
Medicare Star excludes diabetes patients with poor CVD risk factor control.
This study is designed to improve understanding of novel CMS quality measures (adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics) by assessing the proportion of Medicare patients with diabetes who are excluded from the Medicare Star medication adherence metrics due to early nonadherence and insulin use. Medicare’s STAR measures are used to evaluate the performance of Medicare Advantage plans.
AHRQ-funded; HS019859
Citation:
Schmittdiel J, Raebel M, Dyer W .
Medicare Star excludes diabetes patients with poor CVD risk factor control.
Am J Manag Care. 2014 Dec; 20(12):e573-81..
Keywords:
Medicare, Diabetes, Quality Measures, Patient Adherence/Compliance
