Medication therapy management and adherence among US renal transplant recipients

Figures & data

Figure 1 Renal transplant recipient sample inclusion.

Note: Data retrieved from Medicare Parts A, B, and D claims and transplant follow-up data reported in the USRDS.
Abbreviation: USRDS, United States Renal Data System.

Table 1 Characteristics of adult renal transplant recipients (n=17,181)

Characteristics
Mean age ± SD	50.2±14.3
Median (IQR)	51.0 (22.0)
Sex, n (%)
Female	7,021 (40.9)
Male	10,160 (59.1)
Eligibility thresholds for MTM, n (%)
Median thresholds: five or eight Part D drugs, two or three chronic conditions, and US$3,000 or US$4,000 annualized drug costs	7,259 (42.3)
“Low” thresholds: two Part D drugs two chronic conditions, and US$3,000 or US$4,000 annualized drug costs	8,196 (47.7)
“High” thresholds: eight or 15 Part D drugs, three or five chronic conditions, and US$3,000 or US$4,000 annualized drug costs	3,719 (21.7)
Mean number of prescription medications ± SD	9.3±5.3
Median (IQR)	9 (6)
Mean number of chronic conditions ± SD	5.8±2.3
Median (IQR)	5 (3)
Race/ethnicity, n (%)
White	6,959 (40.5)
Black	5,671 (33.0)
Hispanica	3,332 (19.4)
Otherb	1,219 (7.1)
Type of transplant, n (%)
Deceased donor	12,847 (74.8)
Living donor	4,334 (25.2)
Highest education level attained, n (%)
Unknown or attended grades 0–8c	3,677 (21.4)
Attended high school (grades 9–12) or graduate	8,007 (46.6)
Attended college or technical school	3,313 (19.3)
College or postcollege graduated	2,184 (12.7)
Nonadherent (MPR <0.80), n (%)	2,892 (16.8)
Mean MPR ± SD	0.91±0.17
Median (IQR)	1.0 (0.2)

Notes:

a Black and Hispanic: n=155; Other race and Hispanic: n=194; White and Hispanic: n=2,983; Hispanic response of yes or no was unknown for 201 observations.

b Native American: n=209; Asian: n=968; Unknown: n=7; Other: n=35.

c Grade school (grades 0–8): n=1,436; none: n=153; unknown: n=2,087; missing: n=1.

d College or postcollege graduate category: Associate or Bachelor degree: n=1,600; postcollege graduate degree: n=584.

Abbreviations: IQR, interquartile range; MTM, medication therapy management; MPR, medication possession ratio; SD, standard deviation.

Table 2 Associations between adherence and RTRs’ characteristics at 12 months posttransplant, adjusted odds ratios, and 95% confidence intervals

Variable	Adjusted odds ratio	95% confidence interval	P-value
Female vs male	1.19	1.10–1.29	<0.0001
Black vs White	1.10	1.00–1.21	0.06
Hispanic vs White	1.11	0.99–1.25	0.07
Other vs White	1.01	0.86–1.19	0.89
Cadaveric vs living	0.95	0.94–1.04	0.27
MTMa: yes vs no	1.13	1.02–1.26	0.02
Age (10 years)b	0.96	0.93–0.99	0.02
Less than high school vs college degree	0.99	0.86–1.15	0.91
High school vs college degree	1.00	0.88–1.14	0.97
Attended college/technical school vs college degree	0.90	0.78–1.04	0.17
Numbers of prescription drugs	1.01	1.003–1.03	0.02
Numbers of chronic conditions	1.01	0.99–1.03	0.33

Notes:

a MTM eligibility determined using median threshold values: for RTRs transplanted from 2006 to 2009, this was eight Part D drugs and three chronic conditions; for RTRs transplanted 2010 or later, this was five Part D drugs and two chronic conditions.

b Age modeled in 10-year increments beginning at age 18 years.

Abbreviations: MTM, medication therapy management; RTRs, renal transplant recipients.

Table 3 Associations between adherence and RTRs’ characteristics at 12 months posttransplant: adjusted odds ratios and 95% confidence intervals from the reduced model and sensitivity analyses

Model/variable	Adjusted odds ratio	95% confidence interval	P-value
Main analysis/reduced modela
Female vs male	1.19	1.09–1.29	<0.0001
Black vs White	1.09	0.99–1.20	0.09
Hispanic vs White	1.12	1.00–1.25	0.06
Other vs White	1.00	0.85–1.18	0.99
MTM: yes vs no	1.14	1.02–1.26	0.02
Age (10 years)b	0.97	0.94–0.99	0.03
Numbers of prescription drugs	1.02	1.01–1.03	0.002
Sensitivity analysis: “Low” thresholdsc
Female vs male	1.19	1.09–1.29	<0.0001
Black vs White	1.09	0.99–1.20	0.09
Hispanic vs White	1.12	1.00–1.25	0.06
Other vs White	1.00	0.85–1.17	0.99
MTM-low: yes vs no	1.11	1.01–1.22	0.04
Age (10 years)b	0.97	0.94–0.99	0.03
Numbers of prescription drugs	1.02	1.01–1.03	0.0002
Sensitivity analysis: “High” thresholdsd
Female vs male	1.19	1.09–1.29	<0.0001
Black vs White	1.09	0.99–1.20	0.09
Hispanic vs White	1.12	1.00–1.25	0.06
Other vs White	1.00	0.85–1.17	0.99
MTM-high: yes vs no	1.36	1.20–1.56	<0.0001
Age (10 years)b	0.97	0.94–0.99	0.02
Numbers of prescription drugs	1.01	1.00–1.02	0.06

Notes:

a MTM eligibility determined using median threshold values: for RTRs transplanted from 2006 to 2009, this was eight Part D drugs and three chronic conditions; for RTRs transplanted 2010 or later, this was five Part D drugs and two chronic conditions.

b Age modeled in 10-year increments beginning at age 18 years.

c MTM eligibility determined using “low” threshold values: for RTRs transplanted from 2006 to 2009, this was two Part D drugs and two chronic conditions; for RTRs transplanted 2010 or later, this was two Part D drugs and two chronic conditions.

d MTM eligibility determined using “high” threshold values: for RTRs transplanted from 2006 to 2009, this was 15 Part D drugs and five chronic conditions; for RTRs transplanted 2010 or later, this was eight Part D drugs and three chronic conditions.

Abbreviations: MTM, medication therapy management; RTR, renal transplant recipients.