Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation
June
Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation
Majken Linnemann Jensen 0 1 2
Marit Eika Jørgensen 0 1 2
Ebba Holme Hansen 0 1
Lise Aagaard 0 1
Bendix Carstensen 0 1 2
0 Data Availability Statement: The data used in this paper was a combination of data obtained from the Steno Diabetes Center Electronic Patient Record and data from national Danish Registers at Denmark Statistics (DST). The Steno Diabetes Center Electronic Patient Record data were obtained after a written application to the Research and Innovation Office (michelle.anne
1 Editor: Ping-Hsun Wu, Kaohsiung Medical University Hospital , TAIWAN
2 Steno Diabetes Center Copenhagen, Gentofte, Denmark, 2 Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy , Universitetsparken 2 , University of Copenhagen, Denmark, 3 Faculty of Health, University of Southern Denmark , Odense , Denmark
Aims
Methods
Results
Poor initiation rather than poor implementation or discontinuation was the main contributor
to medication nonadherence. Polypharmacy was a risk factor for slower initiation of
treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72±0.87] to 0.89 95%CI
[0.82±0.96] per already prescribed medicine), but once patients were in treatment,
polypharmacy was not associated with recurrence of gaps in supply of medication, and
polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI
[0.86±1.00] to 0.96 95%CI [0.93±0.99] per prescribed medicine). Other identified risk factors
for slow initiation, poor implementation, and discontinuation were diabetes duration,
younger age, and Turkish/Pakistani origin.
). Data from Steno's Electronic Patient
Records and DST were merged by DST and
analyses were performed via a secure VPN
connection. Due to the Danish Act of processing of
personal data, future interested researchers have to
perform the above-mentioned steps to obtain
access to the data.
Funding: This study received funding from The
Danish Agency for Science, Technology and
Innovation, Bredgade 40, DK-1260 Copenhagen K
Grant number: 11-117460 www.http://
innovationsfonden.dk/en, ªdanmarkº
sygeforsikring (a mutual health insurance
company) www.sygeforsikring.dk M.L.J, M.E.J.
and B.C. were employed at Steno Diabetes Center
until 31 December 2016, a diabetes research
hospital and a teaching center owned by Novo
Nordisk A/S, associated with Copenhagen
University Hospital, and working in partnership
with the health authorities of the Capital Region of
Denmark. Steno Diabetes Center A/S received part
of its core funding from unrestricted grants from
the Novo Nordisk Foundation and Novo Nordisk A/
S. M.L.J., M.E.J. and B.C. own shares in Novo
Nordisk A/S. No one at the Novo Nordisk
Foundation or at Novo Nordisk A/S had any role in
study design, data collection and analysis,
decisions to publish, or preparation of the
manuscript. Steno Diabetes Center provided
support in the form of salaries for authors [M.L.J,
M.E.J. and B.C.], but did not have any additional
role in the study design, data collection and
analysis, decision to publish, or preparation of the
manuscript. The specific roles of these authors are
articulated in the `author contributions' section.
Competing interests: M.L.J, M.E.J. and B.C. are
employed at Steno Diabetes Center, a diabetes
research hospital and a teaching center owned by
Novo Nordisk A/S, associated with Copenhagen
University Hospital, and working in partnership
with the health authorities of the Capital Region of
Denmark. Steno Diabetes Center A/S receives part
of its core funding from unrestricted grants from
the Novo Nordisk Foundation and Novo Nordisk A/
S. M.L.J., M.E.J. and B.C. own shares in Novo
Nordisk A/S. This study received part funding from
"danmark" sygeforsikring, Palñgade 5, DK-1261
Copenhagen K, Denmark (a mutual health
insurance company). Sygeforsikringen "danmark"
is a mutual insurance company which specializes
in health insurance. There are no patents, products
in development or marketed products to declare.
This does not alter our adherence to all the PLOS
ONE policies on sharing data and materials, as
detailed online in the guide for authors.
Discussion
This study showed that a risk factor does not necessarily have the same association with all
three elements of adherence (initiation, implementation and discontinuation), and that
efforts supporting patients introduced to more complex drug combinations should be
prioritized.
Introduction
Poor adherence to medication therapy in chronic disease is associated with a worsening of
clinical status/health[
1, 2
], higher risk of hospitalisation[3], risk of medicine-related hospital
admissions[
4
] and higher mortality risk[
5
]. Losing adherence has been shown to be associated
with more hospitalizations and emergency department visits[
6
]. Improving adherence (...truncated)