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Justin Gatwood,1 James E Bailey2 1University of Tennessee Health Science Center, College of Pharmacy, 2University of Tennessee Health Science Center, Center for Health System Improvement, Memphis, TN, USA Abstract: Medication nonadherence is a prevalent public health issue that contributes to significant medical costs and detrimental health outcomes. This is especially true in patients with hypercholesterolemia, a condition affecting millions of American adults and one that is associated with increased risk for coronary and cerebrovascular events. Considering the magnitude of outcomes related to this disease, the medical community has placed significant emphasis on addressing the treatment for high cholesterol, and progress has been made in recent years. However, poor adherence to therapy continues to plague health outcomes and more must be understood and done to address suboptimal medication taking. Here we provide an overview of the reasons for poor medication adherence in patients with hypercholesterolemia and describe recent efforts to curb nonadherence. Suggested approaches for improving medication taking in patients with high cholesterol are also provided to guide practitioners, patients, and payers. Keywords: medication use, lipid management, cardiovascular disease

Aim: To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. Methods: This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. Results: During the first 5 years of oral antidiabetes treatment, people initially non‐adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15–1.28). Veterans with <20% adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27–2.49) and all‐cause death (hazard ratio 1.33, 95% CI 1.17–151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. Conclusions: People who are non‐adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated. What's new?: Medication use is suboptimal in people with diabetes and contributes to poorer health outcomes; however, there has been limited research investigating the extent to which early non‐adherence is predictive of detrimental outcomes beyond the initial years of treatment.The present analysis of US veterans with Type 2 diabetes showed that non‐adherence to oral antidiabetes in the first year of treatment can increase the hazard for certain detrimental health outcomes within the subsequent 5 years of therapy.It is essential to convey the importance of adherence to prescribed therapy from the time of initiating antidiabetes therapy, in order to improve the odds of long‐term, adequate disease management [ABSTRACT FROM AUTHOR]

Despite CDC's recommendation for older adults to receive the herpes zoster (HZ) vaccine, only one-third of the U.S. population >= 60 years have received it. This study aimed to identify the geographic factors and social determinants associated with HZ vaccination. Policy interventions are required to diminish this disparity and improve HZ vaccination. [Extracted from the article]