PMID- 30147305
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220321
IS  - 1177-889X (Print)
IS  - 1177-889X (Electronic)
IS  - 1177-889X (Linking)
VI  - 12
DP  - 2018
TI  - Effect of different methods for estimating persistence and adherence to new 
      glucose-lowering drugs: results of an observational, inception cohort study in 
      Portugal.
PG  - 1471-1482
LID - 10.2147/PPA.S170134 [doi]
AB  - PURPOSE: Several methods have been developed for assessing medication-taking 
      behavior; understanding the determinants and variability in estimates obtained is 
      crucial in interpreting results. We estimated persistence and adherence levels to 
      new glucose-lowering drugs (GLDs) in type 2 diabetes mellitus (T2DM) patients 
      using different methods: through the collection of pharmacy records and combining 
      pharmacy records with self-reported data. METHODS: We conducted a prospective 
      observational cohort study of T2DM patients initiating a new GLD. Data were 
      collected at baseline through interviews (demographic and clinical data). 
      Follow-up data included pharmacy records (refill dates and medication possession) 
      and telephone questionnaires (self-declared monitored GLD refill in another 
      pharmacy, reasons for drug withdrawal). The cohort was divided into incident and 
      prevalent new users. Persistence and adherence (proportion of days covered) were 
      estimated for patients using pharmacy records exclusively (Method 1) and >/=1 
      self-declared statement of being persistent (Method 2). Log-rank tests were used 
      to compare Kaplan-Meier curves of time to nonpersistence. RESULTS: A total of 
      1,328 patients were recruited. When considering Method 1, 38.7% (95% confidence 
      interval [95% CI]: 36.0-41.5) of patients were persistent, whereas combining with 
      self-reported information, this estimate increased to 65.6% (95% CI: 62.9-68.2). 
      Using Method 1, the risk of persistence failure was associated with using an oral 
      GLD, living alone and living in a suburban/urban setting. Three hundred and 
      twenty-seven (24.8%) patients stopped to use the inception GLD. CONCLUSION: 
      Regardless of the method used, results indicated low levels of persistence and 
      adherence to a new GLD; however, when combining self-reported information, higher 
      estimates were obtained. Considering pharmacy records exclusively, prevalent new 
      users, who were more complex patients in terms of T2DM disease but more likely to 
      be pharmacy-loyal patients, were significantly more adherent than the incident 
      new users. Barriers and reasons leading to GLD withdrawal, namely adverse drug 
      event management, should be addressed, since they represent half of the reasons 
      for treatment switching or discontinuation.
FAU - Torre, Carla
AU  - Torre C
AD  - Centre for Health Evaluation & Research (CEFAR), National Association of 
      Pharmacies, Lisboa, Portugal, carla.torre@campus.ul.pt.
AD  - Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University 
      of Lisbon, Lisboa, Portugal, carla.torre@campus.ul.pt.
FAU - Guerreiro, Jose
AU  - Guerreiro J
AD  - Centre for Health Evaluation & Research (CEFAR), National Association of 
      Pharmacies, Lisboa, Portugal, carla.torre@campus.ul.pt.
FAU - Longo, Patricia
AU  - Longo P
AD  - Centre for Health Evaluation & Research (CEFAR), National Association of 
      Pharmacies, Lisboa, Portugal, carla.torre@campus.ul.pt.
FAU - Raposo, Joao Filipe
AU  - Raposo JF
AD  - Nova Medical School, New University of Lisbon, Lisboa, Portugal.
AD  - Portuguese Diabetes Association (APDP), Lisboa, Portugal.
FAU - Leufkens, Hubert
AU  - Leufkens H
AD  - Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for 
      Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
FAU - Martins, Ana Paula
AU  - Martins AP
AD  - Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University 
      of Lisbon, Lisboa, Portugal, carla.torre@campus.ul.pt.
AD  - Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
LA  - eng
PT  - Journal Article
DEP - 20180817
PL  - New Zealand
TA  - Patient Prefer Adherence
JT  - Patient preference and adherence
JID - 101475748
PMC - PMC6103301
OTO - NOTNLM
OT  - daily practice
OT  - discontinuation
OT  - medication use behavior
OT  - type 2 diabetes mellitus
COIS- Disclosure CT was working at CEFAR/National Association of Pharmacies (ANF) when 
      the study was performed and is currently employed by the Portuguese 
      Pharmaceutical Society and has no conflict of interest to declare. JFR has 
      received honoraria for consultancy or giving lectures from Merck Sharp & Dohme, 
      Lilly and Novo Nordisk over the last year. All costs associated with the 
      development and implementation of this study were fully supported by the 
      Portuguese ANF. ANF had no role in study protocol, data analysis or 
      interpretation of this study. The authors report no other conflicts of interest 
      in this work.
EDAT- 2018/08/28 06:00
MHDA- 2018/08/28 06:01
PMCR- 2018/08/17
CRDT- 2018/08/28 06:00
PHST- 2018/08/28 06:00 [entrez]
PHST- 2018/08/28 06:00 [pubmed]
PHST- 2018/08/28 06:01 [medline]
PHST- 2018/08/17 00:00 [pmc-release]
AID - ppa-12-1471 [pii]
AID - 10.2147/PPA.S170134 [doi]
PST - epublish
SO  - Patient Prefer Adherence. 2018 Aug 17;12:1471-1482. doi: 10.2147/PPA.S170134. 
      eCollection 2018.