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Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis
BACKGROUND: Rural residents face numerous barriers to healthcare access and studies suggest poorer health outcomes for rural patients. Therefore we undertook a systematic review to determine if cardiovascular medication utilization and adherence patterns differ for rural versus urban patients. METHO...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064809/ https://www.ncbi.nlm.nih.gov/pubmed/24888355 http://dx.doi.org/10.1186/1471-2458-14-544 |
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author | Murphy, Gaetanne K McAlister, Finlay A Weir, Daniala L Tjosvold, Lisa Eurich, Dean T |
author_facet | Murphy, Gaetanne K McAlister, Finlay A Weir, Daniala L Tjosvold, Lisa Eurich, Dean T |
author_sort | Murphy, Gaetanne K |
collection | PubMed |
description | BACKGROUND: Rural residents face numerous barriers to healthcare access and studies suggest poorer health outcomes for rural patients. Therefore we undertook a systematic review to determine if cardiovascular medication utilization and adherence patterns differ for rural versus urban patients. METHODS: A comprehensive search of major electronic datasets was undertaken for controlled clinical trials and observational studies comparing utilization or adherence to cardiovascular medications in rural versus urban adults with cardiovascular disease or diabetes. Two reviewers independently identified citations, extracted data, and evaluated quality using the STROBE checklist. Risk estimates were abstracted and pooled where appropriate using random effects models. Methods and reporting were in accordance with MOOSE guidelines. RESULTS: Fifty-one studies were included of fair to good quality (median STROBE score 17.5). Although pooled unadjusted analyses suggested that patients in rural areas were less likely to receive evidence-based cardiovascular medications (23 studies, OR 0.88, 95% CI 0.79, 0.98), pooled data from 21 studies adjusted for potential confounders indicated no rural–urban differences (adjusted OR 1.02, 95% CI 0.91, 1.13). The high heterogeneity observed (I(2) = 97%) was partially explained by treatment setting (hospital, ambulatory care, or community-based sample), age, and disease. Adherence did not differ between urban versus rural patients (3 studies, OR 0.94, 95% CI 0.39, 2.27, I(2) = 91%). CONCLUSIONS: We found no consistent differences in rates of cardiovascular medication utilization or adherence among adults with cardiovascular disease or diabetes living in rural versus urban settings. Higher quality evidence is needed to determine if differences truly exist between urban and rural patients in the use of, and adherence to, evidence-based medications. |
format | Online Article Text |
id | pubmed-4064809 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-40648092014-06-21 Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis Murphy, Gaetanne K McAlister, Finlay A Weir, Daniala L Tjosvold, Lisa Eurich, Dean T BMC Public Health Research Article BACKGROUND: Rural residents face numerous barriers to healthcare access and studies suggest poorer health outcomes for rural patients. Therefore we undertook a systematic review to determine if cardiovascular medication utilization and adherence patterns differ for rural versus urban patients. METHODS: A comprehensive search of major electronic datasets was undertaken for controlled clinical trials and observational studies comparing utilization or adherence to cardiovascular medications in rural versus urban adults with cardiovascular disease or diabetes. Two reviewers independently identified citations, extracted data, and evaluated quality using the STROBE checklist. Risk estimates were abstracted and pooled where appropriate using random effects models. Methods and reporting were in accordance with MOOSE guidelines. RESULTS: Fifty-one studies were included of fair to good quality (median STROBE score 17.5). Although pooled unadjusted analyses suggested that patients in rural areas were less likely to receive evidence-based cardiovascular medications (23 studies, OR 0.88, 95% CI 0.79, 0.98), pooled data from 21 studies adjusted for potential confounders indicated no rural–urban differences (adjusted OR 1.02, 95% CI 0.91, 1.13). The high heterogeneity observed (I(2) = 97%) was partially explained by treatment setting (hospital, ambulatory care, or community-based sample), age, and disease. Adherence did not differ between urban versus rural patients (3 studies, OR 0.94, 95% CI 0.39, 2.27, I(2) = 91%). CONCLUSIONS: We found no consistent differences in rates of cardiovascular medication utilization or adherence among adults with cardiovascular disease or diabetes living in rural versus urban settings. Higher quality evidence is needed to determine if differences truly exist between urban and rural patients in the use of, and adherence to, evidence-based medications. BioMed Central 2014-06-02 /pmc/articles/PMC4064809/ /pubmed/24888355 http://dx.doi.org/10.1186/1471-2458-14-544 Text en Copyright © 2014 Murphy et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Murphy, Gaetanne K McAlister, Finlay A Weir, Daniala L Tjosvold, Lisa Eurich, Dean T Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title | Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title_full | Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title_fullStr | Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title_full_unstemmed | Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title_short | Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
title_sort | cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064809/ https://www.ncbi.nlm.nih.gov/pubmed/24888355 http://dx.doi.org/10.1186/1471-2458-14-544 |
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