Predictors of fixed-dose combination antihypertensive drug therapy in a Medicaid population.

Physicians may prescribe hypertension combination therapy, either with fixed-dose combination therapy or with dual-agent component-based therapy. This study evaluated the predictors of hypertensive patients receiving either type of combination therapy. Our study was based on claims data from the Maryland Medicaid Managed Care Organizations. Patients had exclusively used either fixed-dose combination therapy or dual-agent component-based therapy. We used multivariate logistic regression to estimate the impact of age, gender, race, comorbidities, and specific managed care organizations on the likelihood of receiving dual-agent component-based therapy vs. fixed-dose combination therapy. Of a total 2,483 study subjects, 1,270 received dual-agent component-based therapy and 1,213 received fixed-dose combination therapy. Compared with the reference group (Americaid Community Care), Maryland Physicians Care was three times more likely to prescribe dual-agent component-based therapy for its enrollees (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.24 - 4.05). United Healthcare and other managed care organizations were 37% and 57% more likely to have dual-agent component-based therapy than the reference group, respectively (OR, 1.37; 95% CI, 1.08 - 1.74 and OR, 1.57; 95% CI, 1.16 - 2.14). In conclusion, significant prescribing variations exist across managed care organizations. Sickly male patients were more likely to receive the dual-agent component-based therapy. This information can assist future plans in medication therapy management.

Drug therapy persistence and stroke recurrence.

OBJECTIVE: To assess the effect of persistence of use of warfarin sodium, aspirin, or clopidogrel bisulfate on stroke recurrence in a Medicaid high-risk, largely female, African American population. STUDY DESIGN: Prospective non-concurrent cohort, longitudinal data analysis of medical and pharmacy claims of stroke patients from Medicaid managed care organizations between January 1, 2001, and December 31, 2003. METHODS: Cox proportional hazards models were used to predict the likelihood of avoiding a recurrence as a function of persistence of use of the initial medication (warfarin, aspirin, or clopidogrel) after stroke, adjusting for age, race, sex, hypertension and other comorbidities, and the pharmacotherapies prescribed. We used propensity scores to adjust for confounding by indication. RESULTS: Among 925 stroke patients (64.6% female, 75.1% > or =50 years, and 57.8% African American), hypertension and heart disease were the most prevalent comorbidities (66.1% and 65.1%, respectively); most initial strokes were nonhemorrhagic. Persistence of use of warfarin, aspirin, or clopidogrel after stroke increased the likelihood of avoiding a recurrence (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.22-2.01). Having a hemorrhagic stroke initially (HR, 0.37; 95% CI, 0.18-0.74) or having heart disease (HR, 0.82; 95% CI, 0.67-1.01), hypertension (HR, 0.63; 95% CI, 0.51-0.79), or diabetes mellitus (HR, 0.74; 95% CI, 0.60-0.91) after an initial stroke significantly decreased the likelihood of avoiding a recurrence. Patient's age, race, sex, and urban residence did not significantly predict the likelihood of avoiding a recurrence. CONCLUSIONS: Persistence of use of the initial stroke preventive medication after stroke is effective in avoiding a recurrence. Hemorrhagic stroke, heart disease, hypertension, and diabetes increase the likelihood of a recurrence.