Drug adherence gender gap

Despite the growing research interest in medication adherence during the (Callie Jones)past decade, little work has been done to see whether there are differences between women and men in terms of adherence.

In this context, the findings of a new study conducted by a US pharmacy benefit manager, Medco Health Solutions, makes for interesting reading. Not only does it show a gender gap in adherence but it also highlights the role that pharmacists can play in the pharmaceutical care of women.

Among the study’s findings, based on 30 million prescription records from January to December 2010, women were prescribed an average of five medicines while men were prescribed an average of 3.7 items. More women than men (68 per cent versus 59 per cent) took at least one chronic or acute medicine during the study period. However, women were less likely to adhere to their prescribed drug regimens.

Differences were most dramatic among patients with diabetes and cardiovascular disease, where women had poorer outcomes than men in 25 out of 25 clinical measures. The study showed that only 30 per cent of women with diabetes tested their blood glucose levels compared with

35 per cent of men, while only 66 per cent of women had a HbA1c test compared with more than 70 per cent of men. Women also had lower adherence rates for cholesterol lowering drugs and other cardiovascular medicines.

Moreover, despite being prescribed more drugs than men, women were less likely to be prescribed drugs according to clinical guidelines.

The data did not reveal why women are less adherent or why doctors appear to prescribe differently for women in relation to guidelines. Outcomes in terms of adverse effects and health improvement were not measured in this study, but it is possible that women had different experiences with their medication.

Pharmacokinetic studies have demonstrated differences between women and men, but given that drug doses are often designed from the results of research conducted in men, these doses may not always be appropriate for women.

In another recent US study looking specifically at asthma, women were less adherent than men in their use of inhalers, including corticosteroids,

long-acting beta-agonists and combinations of the two. On the other hand, women were more adherent than men for leukotriene receptor antagonists.

Researcher Leslie Hinyard noted that an explanation could be that women were more used to taking pills than men, rather than that men were more apt at using inhalers. However, there were no significant differences between men and women for oral steroid use, theophylline or monoclonal antibodies.

The findings from these studies point to the need for pharmacists to consider gender when conducting medicines management, dispensing and reporting adverse events. Perhaps pharmaceutical care plans also need to be personalised according to gender. Have any pharmacists suspected or encountered adherence differences between women and men? If so, perhaps they could share their thoughts so that awareness can be raised and understanding improved.


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