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Objective: To determine adherence patterns for thiazide diuretics, alkali citrate therapy, and allopurinol, collectively referred to as preventive pharmacological therapy (PPT), among patients with kidney stones., Methods: Using medical claims data, we identified adults diagnosed with kidney stones between 2002 and 2006. Through National Drug Codes, we determined those with one or more prescription fills for a PPT agent. We measured adherence to PPT (as determined by the proportion of days covered formula) within the first 6 months of starting therapy and performed multivariate analysis to evaluate patient factors associated with PPT adherence., Results: Among 7980 adults with kidney stones who were prescribed PPT, less than one third (30.2%) were adherent to their regimen (indicated by proportion of days covered  ≥ 80%). Among those on monotherapy, rates of adherence differed by the type of PPT agent prescribed: 42.5% for thiazides, 40.0% for allopurinol, and 13.4% for citrate therapy. Factors that were independently associated with lower odds of PPT adherence included combination therapy receipt, female gender, less generous health insurance, and residence in the South or Northeast. In contrast, older patients and those with salaried employment had a higher probability of PPT adherence., Conclusion: Adherence to PPT is low. These findings help providers identify patients where PPT adherence will be problematic. Moreover, they suggest possible targets for quality improvement efforts in the secondary prevention of kidney stones., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To examine the variation in the quality of secondary prevention for nephrolithiasis across health care markets., Methods: Using analytical files from Litholink Corporation (2003-2012), we identified adults with nephrolithiasis and abnormal urine biochemistries on 24-hour urine collection. After assigning all patients to a hospital referral region (HRR), we determined the proportion of patients in each HRR who underwent on-treatment follow-up testing (our measure of quality). We then fitted multivariate hierarchical regression models to quantify the amount of variation in this proportion across HRRs. Finally, we examined for associations between a patient's odds of on-treatment follow-up testing and the supply of primary care and specialist physicians in an HRR., Results: The mean rate on-treatment follow-up testing was exceedingly low at only 11.9%. This rate has been stable over time. There was fourfold variation in this rate across HRRs from as little as 6.6% to as high as 23.4%. Those HRRs with higher on-treatment follow-up testing rates tended to have a wealthier and more educated population (P = .01). Receipt of on-treatment follow-up testing was not associated with the number of specialists per capita., Conclusion: Wide geographic variation exists in the quality of secondary prevention for patients with nephrolithiasis. Given that current guidelines recommend on-treatment follow-up testing, efforts to increase its uptake are needed., (Published by Elsevier Inc.)