1. For patients with diabetes, hypertension, and hyperlipidemia, receiving care from a patient-centered medical home was associated with better medication adherence compared to a control practice located in the same service area.
2. These findings are an important consideration for physicians, policymakers, and health plans seeking to improve quality of care for patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Medication adherence for chronic conditions has been of increasing concern for physicians and payers. Unsatisfactory adherence is markedly associated with poorer patient outcomes and greater health care spending. Therefore, medication adherence is an important measure of quality of care. This study evaluated the relationship between patient-centered medical homes and medication adherence for certain chronic conditions. Using claims from a large national health insurer, this retrospective cohort study found that medication adherence for diabetes, hypertension, and hyperlipidemia was higher compared to control practices in the same service area for the evaluation period of 12 months after treatment initiation. This information could be of important consideration for physicians, policymakers, and health plans seeking to improve quality of care for patients.
A strength of the study is that it evaluated medication adherence in the setting of the medical home, which had only been previously carried out by a single study concerning North Carolina Medicaid beneficiaries. In contrast, this study covered a geographical area on the national level. A limitation of the study is that clinical outcomes were not evaluated. Another limitation is that the cohort was limited to patients who were commercially insured.
In-Depth [retrospective cohort]: This study studied medication adherence for three common chronic diseases: diabetes, hypertension, and hyperlipidemia. The authors used Aetna administrative claims data to identify patients who began using an oral hypoglycemic, antihypertensive, or cholesterol-lowering statin medication between 01/01/11 and 12/31/13. There were 18 611 patients who both met study criteria and received care from a medical home meeting National Committee for Quality Assurance (NCQA) criteria. Medication adherence was evaluated for the 12-month period after treatment began. Medication adherence in these patients were compared to a control practice located in the same service area. There were 4660 matched control and medical home practices. Among medical home patients, mean rates of adherence were 64% compared to 59% among control patients. Medication adherence was 2.2% (95%CI 1.5% to 2.9%) higher in medical homes. Increased medication adherence was observed for all three disease states studied. For diabetes, hypertension, and hyperlipidemia, the values were 3.0% (CI 1.5% to 4.6%), 3.2% (CI 2.2% to 4.2%), and 1.5% (CI 0.6% to 2.5%), respectively.
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