Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Pharmacy

First Advisor

, Leanne Lai

Defense Date

1-1-2016

Abstract

Background: More than one third of American adults have been diagnosed with high blood cholesterol over the past decade but less than half of them received treatment. Untreated hyperlipidemia can lead to coronary heart disease (CHD). The study aimed to examine the association between socioeconomic factors and the use of antihyperlipidemic agents for patients with hyperlipidemia. Methods: A retrospective cohort study was undertaken using data from the 2012 Medical Expenditure Panel Survey (MEPS). Study sample consisted of adults aged 20 years and older with hyperlipidemia diagnoses. A series of descriptive statistics and weighted logistic regression were used to evaluate the association between socioeconomic factors and the use of hyperlipidemic pharmacotherapy. The Andersen Behavioral Model (ABM) was adapted to identify these factors. The likelihood ratio tests were utilized to examine the ABM components. The global Chi-square statistics were performed to assess configural invariance among models. The receiver operating characteristic (ROC) curves and the automatic variable selection (AVS) were utilized as sensitivity analyses. Results: Approximately 44 million patients age 20 years and older were diagnosed with hyperlipidemia. Among these, 82.8% received at least one antihyperlipidemic agent. The results from hierarchical logistic regression showed that predisposing, enabling and need factors were significantly enhanced the overall fitness of the model (p = <.001). C-statistics and ROC curves revealed that the logistic models had an adequate discrimination power. The sensitivity analyses showed that all methods of AVS agreed on most of the significant independent predictors. Conclusion: This study successfully adapted ABM to assess significant association between socioeconomic factors and the use of antihyperlipidemic agents. There is a need for public health policies that increase awareness of disparities in hyperlipidemia therapy while expanding coverage for underserved patients. Pharmacists can exercise their specialized skills and knowledge to recommend treatments for eligible patients which ultimately improves the overall patients’ quality of care.

Subject Categories

Pharmacy and Pharmaceutical Sciences

Keywords

Pharmacoeconomics and outcomes research; Social Administrative Pharmacy

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