Endourology and StonesFactors Associated With Preventive Pharmacological Therapy Adherence Among Patients With Kidney Stones
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Data Source and Study Population
For our study, we used Truven Health Analytics MarketScan Commercial Claims and Encounters Database (2002 to 2006). This longitudinal database contains medical and drug claims from a population of working-age adults with employer-sponsored insurance and their dependents.
Through an established International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) code-based algorithm,11 we identified adults between the ages 18 and 64 years old with a diagnosis of urinary stone
Results
Among the 7980 beneficiaries who met our study's inclusion criteria, majority were on thiazide (40.5%) or citrate (30.1%) monotherapy. Combination therapy was infrequently prescribed (Table 1). Among those on monotherapy, adherence rates were highest for thiazides (42.5%), followed by allopurinol (40.0%) and citrates (13.4%). Regardless of the agent prescribed, adherence to monotherapy was higher than combination therapy (31.4% vs 23.3%, P < .001 for the comparison). Our findings were robust
Discussion
The present study explored PPT adherence rates among working-age adults with kidney stones. In a cohort of 7980 patients, less than 1 in 3 patients were adherent to prescribed therapy. Increasing age, salaried employees, those with greater generosity of insurance, and residence in the Midwest were associated with a higher probability of medication adherence. However, receipt of combination therapy was associated with a lower probability of PPT adherence.
Although prescription of PPT is
Conclusion
Limitations notwithstanding, our study is important in that it is the first to describe adherence to preventive pharmacologic therapy agents in patients with kidney stones. We observed that only 30.2% of patients were adherent to prescribed therapy. Although recent studies suggest favorable clinical implications related to adherence to PPT with regard to future stone events, the economic implications of these findings on patients with kidney stones are unclear. That said, our analysis will help
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Cited by (29)
Kidney Stone Prevention
2023, Advances in NutritionImpact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones
2021, Asian Journal of UrologyCitation Excerpt :The study was conducted in a third level hospital, with a specialized lithiasis clinic, in which complex and recurrent cases of kidney stones are treated so that it could be not representative of the general population. Although the follow-up time of our population could be considered a short time follow-up for chronic diseases, all the previous studies evaluating adherence to medical treatment have reported just 6 months of follow-up [16–18]. Long-term follow-up is necessary to document the constancy to adherence in chronic treatments and to observe changes in the 24-hour urinary metabolic study and its long-term effect on recurrence rate changes, stone re-formation, emergency visits, and even loss of kidney function.
Medical therapy for nephrolithiasis: State of the art
2018, Asian Journal of UrologyCitation Excerpt :Although multiple RCTs have shown a benefit of pharmacotherapy in preventing stone recurrence, compliance with prescribed drug regimens is often suboptimal. Using medical claims data, Dauw and colleagues [94] found that only 30.2% of kidney stone patients who were prescribed medications for stone prevention adhered to their drug regimen. Factors that were independently associated with lower likelihood of adherence included combination drug therapy, female gender, less comprehensive health insurance and residence in the South or Northeast of United States.
Association between low-testosterone and kidney stones in US men: The national health and nutrition examination survey 2011–2012
2018, Preventive Medicine Reports
Financial Disclosure: Khurshid R. Ghani is a consultant for Lumenis and Boston Scientific. J. Stuart Wolf has a financial relationship with Urology Times. Brent K. Hollenbeck has a financial relationship with Urology as an editor. John M. Hollingsworth has a financial relationship with the AHRQ and Urology Care Foundation. The remaining authors declare that they have no relevant financial interests.
Funding Support: This work is supported by a grant from the AHRQ and the Urology Care Foundation, 1K08HS020927-01A1.