Gender gap in medication management

Mar 19 2012

There is a wide gender divide when it comes to how men and women are prescribed and adhere to their medications.  According to a new study, while women use more prescription drugs than men, they are less likely to be prescribed drugs according to clinical guidelines and are not as good about adhering to the medications they are prescribed.  The research was conducted by Medco Health Solutions, Inc. (NYSE: MHS) and the Society for Women's Health Research and presented Saturday at Women's Health 2012: The 20th Annual Congress.

The study found that women of all ages use more medications – an average of five drugs, compared to less than four (3.7) drugs for men, and that more women than men (68 percent versus 59 percent) took at least one chronic or acute medication during the study period.  The higher average persisted even after accounting for prescription contraceptives.

Despite higher utilization of medications, women were overall less adherent than men and not prescribed treatments in alignment with recommended guidelines as often as men.  Differences were most dramatic among patients with cardiovascular disease and diabetes where women showed poorer outcomes than men in 25 out of 25 clinical measures. 

For women, electing not to take a medication after they have already started could be due to a variety of reasons, including: adverse side effects; inability to tolerate the medication; or failure to see or feel improvements in their health.  Some of these responses could be due to the fact that women are oftentimes prescribed drugs with guidelines and dosing based on research conducted predominately on male subjects.

"It has long been demonstrated that there are physiological differences in women that affect their absorption and metabolism of medications, but this knowledge has not yet been widely translated into gender-specific dosing," said Amy Steinkellner, PharmD, National Practice Leader, Medco Women's Health Therapeutic Resource Center®.  "To improve clinical care, avoid misdosing and potentially avoidable side effects in women, it is critical to consider gender in every aspect of drug development and management, from research and reporting of results all the way through to a personalized medicine treatment plan."

The study examined prescription claims for nearly 30 million insured Americans ages 18 and older over the course of one year (January 1, 2010 to December 31, 2010).  For the purposes of this study, adherence was measured according to the medication possession ratio (MPR), the percent of days that the patient has medication available over the study period. An MPR of 80 percent or higher is considered adherent.

Women Lag Behind Men in Both Diabetes and Cardiovascular Disease ManagementAccording to the Centers for Disease Control and Prevention, more than half of those living with diabetes are women.  However, the Medco study showed that men far surpassed women when it came to diabetic adherence to prescribed medications, monitoring and management tools.  In fact, of the 14 clinical categories in diabetes, men outperformed women in all 14.

Specifically, 30 percent of women tested blood glucose using test strips, compared with 35 percent of men; approximately 66 percent of women had an A1C test – a measure of blood sugar over time – compared to more than 70 percent of men.

Of those with cardiovascular disease – the number one killer of women in the U.S. – women fared worse than men in 11 out of 11 clinical metrics.  Use of cholesterol reducing medication in the presence of coronary artery disease was seen in only 59 percent of women, compared with 71.5 percent of men.  Regarding use of beta blockers following a heart attack, 63 percent of women used the medications, compared to 69 percent of men.

"Despite all the advances in medicine over the last century, we have a long way to go in reducing these needless disparities in women's health care," said Phyllis Greenberger, President and CEO of Society for Women's Health Research. "We need to emphasize more research on women from the very beginning of the drug discovery process, as well as commit to understanding all the factors that affect her adherence to medications for the long-term."

Bridging the Gender Gap in Medication ManagementAlthough women have demonstrated higher utilization for preventive care services, such as cholesterol monitoring, colon cancer screening and immunizations, they are falling short when it comes to treating conditions via medication management. 

Through its Women's Health Therapeutic Resource Center (TRC), Medco specialist pharmacists are able to identify adherence issues and omissions in care among patients, then work with physician and patients to resolve the issues and reduce gaps in care.