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Original Articles

Sociodemographic and Clinical Characteristics Are Not Clinically Useful Predictors of Refill Adherence in Patients With Hypertension

John F. Steiner, MD, MPH; P. Michael Ho, MD, PhD; Brenda L. Beaty, MSPH; L. Miriam Dickinson, PhD; Rebecca Hanratty, MD; Chan Zeng, PhD; Heather M. Tavel, BS; Edward P. Havranek, MD; Arthur J. Davidson, MD, MSPH; David J. Magid, MD, MPH and Raymond O. Estacio, MD

From the Colorado Health Outcomes Program (J.F.S., B.L.B., L.M.D.), the Departments of Family Medicine (L.M.D.) and Preventive Medicine and Biometrics (D.J.M.), and the Division of Emergency Medicine (D.J.M.), University of Colorado, Denver, Colo; the Department of Medicine (P.M.H.), Denver Veterans Affairs Medical Center, Denver, Colo; Denver Health (R.H., E.P.H., A.J.D., R.O.E.), Denver, Colo; the Institute for Health Research (J.F.S., C.Z., H.M.T., D.J.M.), Kaiser Permanente Colorado, Denver, Colo; and the Denver Department of Public Health (A.J.D.), Denver, Colo.

Correspondence to John F. Steiner, MD, MPH, Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237-8066. E-mail john.f.steiner{at}kp.org

Received December 9, 2008; accepted July 9, 2009.

Background— Although many studies have identified patient characteristics or chronic diseases associated with medication adherence, the clinical utility of such predictors has rarely been assessed. We attempted to develop clinical prediction rules for adherence with antihypertensive medications in 2 healthcare delivery systems.

Methods and Results— We performed retrospective cohort studies of hypertension registries in an inner-city healthcare delivery system (n=17 176) and a health maintenance organization (n=94 297) in Denver, Colo. Adherence was defined by acquisition of 80% or more of antihypertensive medications. A multivariable model in the inner-city system found that adherent patients (36.3% of the total) were more likely than nonadherent patients to be older, white, married, and acculturated in US society, to have diabetes or cerebrovascular disease, not to abuse alcohol or controlled substances, and to be prescribed fewer than 3 antihypertensive medications. Although statistically significant, all multivariate odds ratios were 1.7 or less, and the model did not accurately discriminate adherent from nonadherent patients (C statistic=0.606). In the health maintenance organization, where 72.1% of patients were adherent, significant but weak associations existed between adherence and older age, white race, the lack of alcohol abuse, and fewer antihypertensive medications. The multivariate model again failed to accurately discriminate adherent from nonadherent individuals (C statistic=0.576).

Conclusions— Although certain sociodemographic characteristics or clinical diagnoses are statistically associated with adherence to refills of antihypertensive medications, a combination of these characteristics is not sufficiently accurate to allow clinicians to predict whether their patients will be adherent with treatment.

Key Words: pharmaceutical preparations • hypertension • prevention & control • medication adherence

Guest Editor for this article was Viola Vaccarino, MD, PhD.