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    Predictors of very low adherence with medications for osteoporosis: towards development of a clinical prediction rule

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    Authors
    Solomon, Daniel H.
    Brookhart, M. Alan
    Tsao, Peter
    Sundaresan, Devi
    Andrade, Susan E.
    Mazor, Kathleen M.
    Yood, Robert A.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2011-06-30
    Keywords
    Medication Adherence
    Osteoporosis
    Health Services Research
    Primary Care
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1007/s00198-010-1381-4
    Abstract
    We developed a clinical prediction rule score to predict medication non-adherence for women prescribed osteoporosis treatment. When combined into a summative score, 62% with seven or more points on the score demonstrated very low adherence. This compares with 17% subjects with fewer than seven points (c-statistic = 0.74). INTRODUCTION: Medication non-adherence is extremely common for osteoporosis; however, no clear methods exist for identifying patients at risk of this behavior. We developed a clinical prediction rule to predict medication non-adherence for women prescribed osteoporosis treatment. METHODS: Women undergoing bone mineral density testing and fulfilling WHO criteria for osteoporosis were invited to complete a questionnaire and then followed for 1 year. Adjusted logistic regression models were examined to identify variables associated with very low adherence (medication possession ratio <20%). The weighted variables, based on the logistic regression, were summed, and the score was compared with the proportion of subjects with very low adherence. RESULTS: One hundred forty two women participated in the questionnaire and were prescribed an osteoporosis medication. After 1 year, 36% (n = 50) had very low adherence. Variables associated with very low adherence included prior non-adherence with chronic medications, agreement that side effects are concerning, agreement that she is taking too many medications, lack of agreement that osteoporosis is a worry, lack of agreement that a fracture will cause disability, lack of agreement that medications help her stay active, and frequent use of alcohol. When combined into a summative score, 36 of the 58 subjects (62%) with seven or more points on the score demonstrated very low adherence. This compares with 14 of the 84 (17%) subjects with fewer than seven points (c-statistic = 0.74). CONCLUSION: We developed a brief clinical prediction rule that was able to discriminate between women likely (and unlikely) to experience very low adherence with osteoporosis medications.
    Source
    Osteoporos Int. 2011 Jun;22(6):1737-43. Epub 2010 Sep 29. Link to article on publisher's site
    DOI
    10.1007/s00198-010-1381-4
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/36886
    PubMed ID
    20878392
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00198-010-1381-4
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