Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare.

Academic Article

Abstract

  • INTRODUCTION: Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS: In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS: Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION: About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
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    Keywords

  • Adherence, Epilepsy, Medicare, Older adults, Part D coverage, Age Factors, Aged, Aged, 80 and over, Anticonvulsants, Cohort Studies, Cost-Benefit Analysis, Epilepsy, Ethnic Groups, Female, Humans, Male, Medicare Part D, Medication Adherence, Retrospective Studies, United States
  • Digital Object Identifier (doi)

    Author List

  • Piper K; Richman J; Faught E; Martin R; Funkhouser E; Szaflarski JP; Dai C; Juarez L; Pisu M
  • Start Page

  • 68
  • End Page

  • 73
  • Volume

  • 66