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Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users
Nordic School of Public Health, Gothenburg, Sweden / Unit for Social Epidemiology, Clinical Research Centre, Faculty of Medicine, Lund University, Lund, Sweden.ORCID iD: 0000-0003-4616-9525
Department of Forensic Genetics and Forensic Toxicology, National Board Forensic Medicine, Linköping, Sweden.
Nordic Health Economics AB, Gothenburg, Sweden.
Research and Development, Sahlgrenska University Hospital, Gothenburg, Sweden / Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155465Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden.

STUDY DESIGN AND SETTING: New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance.

RESULTS: The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis.

CONCLUSION: The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.

Place, publisher, year, edition, pages
2016. Vol. 11, no 5, article id e0155465
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Health Sciences
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URN: urn:nbn:se:his:diva-14624DOI: 10.1371/journal.pone.0155465ISI: 000376286100051PubMedID: 27192203Scopus ID: 2-s2.0-84971425317OAI: oai:DiVA.org:his-14624DiVA, id: diva2:1171063
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved

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Bjerkeli, Pernilla J.

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