IMS Health: Compliance with diabetes still needs improvement
15.06.2015 15:24
A key goal of health services research is to examine the treatment of illnesses under everyday conditions and, if possible, to consider approaches for improvement. Using the example of type 2 diabetes mellitus, IMS Health examined the compliance of patients in everyday life and whether there are differences in adherence to therapy depending on sociodemographic characteristics, pharmacotherapy and type of specialist training. The results show that there are no differences in terms of gender, but there are differences in terms of the age of the patients and the type of drug therapy: with increasing age, adherence to therapy improves significantly and taking oral antidiabetic drugs has just as much of a compliance-promoting effect as diabetological treatment Focus practices.
Diabetes mellitus is a widespread disease. According to various information1 In Germany, around 8 % of the adult population are affected. As a result of this high prevalence and sometimes complex treatment
comparatively high costs arise. For the patients, the disease is due to the chronicity, diagnostic measures such as blood sugar control and, if necessary. Injecting insulin is stressful, plus the potential life-threatening effect of hypoglycemia.
Improving non-adherence is generally considered to be one of the most important variables for achieving savings in healthcare spending, as the IMS Institute for Healthcare Informatics has generally found2. In connection with the above-mentioned facts about the disease diabetes
Both individual and social benefits can be expected from an improvement in compliance if adherence to therapy for this indication is not optimal. IMS Health investigated this question.
The database was formed by the IMS® DIAREG disease register, which includes anonymized, prospectively collected data in addition to epidemiological key figures. In combination with anonymous treatment courses from the IMS® Disease Analyzer database, which enables a retrospective analysis, a total of 983 patients from 76 general practitioners and 155 patients from 9 diabetology practices were included in the study for the years 2013 and 2014.
Results
Patient compliance was assessed by the treating physicians on a six-point scale from “very poor” to “very good”. Patients with an assessment of “good” or “very good” were considered compliant. All patients included in the study were treated with oral antidiabetic drugs (OADs) or insulin for at least six months.
The analyzes examine the possible influencing factors on therapy adherence
some interesting results. While men and women do not differ in terms of compliance, adherence to therapy improves statistically significantly as the patient ages. Around 63 % of 40 to 60-year-olds are classified by doctors as adherent to therapy, but 69 % of 61 to 70-year-olds and 74 % of those over 70 are classified.
The type of pharmacotherapy also plays a role: of the patients who are on oral antidiabetic drugs, around 75 % are assessed as compliant, significantly more than with therapy using insulin (67 %) or even a combination therapy of both medications (59 % ). Finally, in diabetological practices, more patients (78 %) are recognized as having higher compliance than in general practitioner practices (69 %).
The reasons behind these differences would need to be examined in a further step in order to specifically work towards improving compliance. If, for example, poorer adherence to therapy in younger people were due to a different assessment of the illness, this might be the case. to begin with education and information about the disease and the therapy; However, if, for example, it plays a role in reconciling the handling of therapy with everyday management, then assistance and individual advice might be a possible option here.
However, an important limitation must be taken into account when interpreting the results. The assessment of compliance involves subjective assessments by doctors, and it cannot be ruled out that they also classify adherence to therapy as dependent on blood sugar levels.
Even if the compliance rates reported here are rather high compared to other diseases 3, the subgroup analyzes show that there is still a need for improvement. Or, like Prof. Dr. Karel Kostev, Senior Research Advisor at IMS Health, explains: “As we have discovered, there is a need for improvement in terms of compliance, especially among the younger group of type 2 diabetes patients. Optimizing these patients' adherence to therapy is important for them, given their perspective on life. In addition, in the course of demographic change, an aging society in particular must generally have an interest in achieving the best possible compliance with chronic illnesses, which then affect more and more people, because this helps to save costs.
1 See e.g. Robert Koch Institute (ed.) (2014) Diabetes mellitus. Fact sheet on GEDA 2012: Results of the study “Health in Germany Current 2012”. RKI, Berlin www.rki.de/geda (as of October 25, 2014)
2 IMS Institute for Healthcare Informatics, 2012: Responsible Use of Medicines Report. Link: www.imshealth.com/