1. Cardiovascular risk (CVR) management and medication adherence Jim Warren Professor of Health Informatics

2. The footprints of computer-based care General practice electronic medical records (EMRs) - “practice management system, PMS” data as we say in NZ – Excellent record of prescribing, plus increasingly good cardiovascular risk (CVR) scores and supporting values (e.g. blood pressures) National collections – Allow linkage, notably to dispensing, but [as yet] only for public health profile, not decision support at point of care Worked with West Fono Health Care (and ~20 others) – Pacific led practice in West Auckland In Australia, 45 and Up Study – Survey of 250,000 NSW people aged 45+ – Linked to national collections

3. The confronting issue: under-supply Most prescriptions provide 90 days supply Alas, gaps – big and little – are commonplace Percent of days covered over a time period = Medication Possession Ratio (MPR). MPR < 80% implies significant non-adherence

4. What we’ve found NZ: qualitative (n=20) – Samoan high adherers to BP meds cite family support and trust of GP; low adherers note transport issues, family commitments Aus: quantitative (n=58000) – Statin adherence lower when Language Other Than English (LOTE) spoken at home, high psych distress, smoker; better when older, prior CVD, comorbidities NZ: quantitative (n=1200) – Among Pacific patients with high CVR, about 2/3 rd high adherers to BP and oral glycaemic meds; less than ½ to statins – high adherers have better physiological measures NZ: intervention (n=200) – Nurses provided with low adherer lists and time significantly improved MPR (dispensing as well as prescribing) versus control practice