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Decomposing the effect of drug benefit program on antihypertensive medication adherence among the elderly in urban China

Authors Ma X, Zhang Y, Zhang M, Li X, Yin H, Li K, Jing M

Received 15 January 2019

Accepted for publication 19 June 2019

Published 11 July 2019 Volume 2019:13 Pages 1111—1123

DOI https://doi.org/10.2147/PPA.S201707

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Dr Naifeng Liu


Xiaochen Ma1,*, Yuji Zhang2,*, Mei Zhang,2 Xiaoju Li,2 Hongpo Yin,2 Ke Li,3 Mingxia Jing2

1China Center for Health Development Studies, Peking University, Beijing 100000, People’s Republic of China; 2Department of Public Health, Shihezi University School of Medicine, Shihezi 832002, Xinjiang, People’s Republic of China; 3Department of Orthopedics, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi 832002, Xinjiang, People’s Republic of China

*These authors contributed equally to this work

Purpose: Hypertension is a rapidly growing epidemic in People’s Republic of China, yet it remains inadequately controlled. This study aimed to identify the relative contributions of program effects and patients’ characteristics to the differences in antihypertensive medication nonadherence between drug benefit program enrollees and non-enrollees.
Patients and methods: Data were from a cross-sectional survey of 1,969 community-dwelling elderly adults with hypertension. Self-reported adherence was measured following previous studies in People’s Republic of China. The Blinder-Oaxaca nonlinear decomposition method was used to identify the relative contributions of program effects and patients’ individual characteristics.
Results: Eleven percent of the drug benefit program enrollees were nonadherent to their medication, while 17% of non-enrollees were. Blinder-Oaxaca decomposition identified that over 60% of the gap between the two groups was due to the program effects (P=0.024). The rest could be explained by differences in observable characteristics (P<0.001), such as diabetic status, duration of hypertension, and blood pressure control.
Conclusion: The study confirmed that drug benefit program enrollees were more likely to be adherent to their antihypertensive medication than non-enrollees in the context of People’s Republic of China.

Keywords: medication adherence, drug benefit program, decomposition, hypertension

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