Antihypertensive adherence and drug class among Asian Pacific Americans.

OBJECTIVE: Research on adherence has emphasized the need to consider patient ethnicity when developing adherence plans. The objective of this study is to identify predictors of adherence for specific groups, particularly Asian Americans and Pacific Islanders. METHODS: We examined the factors, including drug class, associated with antihypertensive adherence for 28,395 adults in Hawaii (July 1999-June 2003) using health plan administrative data. The population included Japanese (n=13,836), Filipino (n=3,812), Chinese (n=2,280), Korean (n=450), part-Hawaiian (n=3,746) and white (n=3,920) patients. Members with antihypertensive medication in their possession >or=80% of the time were considered adherent. Multivariable logistic regression models were used to identify factors associated with adherence. RESULTS: Overall adherence rates were less than 65% among all racial/ethnic groups. After adjustment for patient age, gender, morbidity level, health plan type, isle of residence, comorbidities and year of treatment, Japanese were more likely than whites to adhere to antihypertensive therapy [OR=1.21 (1.14-1.29)], whereas Filipino [OR=0.69 (0.64-0.74)], Korean [OR=0.79 (0.67-0.93)] and Hawaiian [OR=0.84 (0.78-0.91)] patients were less likely to adhere. These results were consistent across therapeutic class. Other patient factors associated with lower adherence included younger age, higher morbidity and history of heart disease. Patient factors were also significantly related to adherence, including gender and seeing a sub-specialist. Seeing a physician of the same ethnicity did not appear to improve adherence. CONCLUSIONS: Our findings of substantial disparities among Asian Pacific American subgroups highlight the need to examine subgroups separately. Future qualitative research is needed to determine appropriate interventions, particularly for Filipino, Korean and Hawaiian patients.

A health plan intervention to improve pneumococcal vaccination in the elderly.

In 1998, the Hawaii Medical Service Association, headquartered in Honolulu, partnered with a pharmaceutical manufacturer to promote pneumococcal immunization of its 33,017 Medicare cost-contract members. They disseminated newsletter articles, magazine advertisements, letters, posters, and broadcast announcements; held injection clinics; and provided physicians reminder postcards with patient labels. Medicare claims indicated that immunization rose by 13.3% in 1997, 20.7% in 1998, and 42.3% in 2000, exceeding rates in a fee-for-service control group. Moreover, the rate of hospitalization for pneumococcal pneumonia dropped after 1998. The data suggest that multimodal promotion of pneumococcal vaccine will result in more extensive immunization and less frequent hospitalization.

Patient characteristics, health status, and health-related behaviors associated with obesity.

The objective of this study was to identify factors associated with obesity and to examine the health habits of the obese and non-obese. In this study of over 44,000 insured individuals, obesity rates increased with age until age 65 and were highest among members of Samoan ancestry. Because the causes of obesity are multi-faceted, treatment approaches may need to address diet, exercise, pharmacotherapy and management of comorbid conditions.