Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost

Department of Medical Affairs, Medco Health Solutions, Inc., Franklin Lakes, New Jersey 07417, USA.
Medical Care (Impact Factor: 3.23). 07/2005; 43(6):521-30. DOI: 10.1097/
Source: PubMed


The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure.
The authors conducted a retrospective cohort observation of patients who were continuously enrolled in medical and prescription benefit plans from June 1997 through May 1999. Patients were identified for disease-specific analysis based on claims for outpatient, emergency room, or inpatient services during the first 12 months of the study. Using an integrated analysis of administrative claims data, medical and drug utilization were measured during the 12-month period after patient identification. Medication adherence was defined by days' supply of maintenance medications for each condition.
The study consisted of a population-based sample of 137,277 patients under age 65.
Disease-related and all-cause medical costs, drug costs, and hospitalization risk were measured. Using regression analysis, these measures were modeled at varying levels of medication adherence.
For diabetes and hypercholesterolemia, a high level of medication adherence was associated with lower disease-related medical costs. For these conditions, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence.
For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

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Available from: Michael C Sokol, Mar 23, 2014
    • "Yet, adhering to prescribed medications is a major issue affecting health care because nonadherence has been associated with worsening clinical symptoms and disease progression [2] [3] [4] [5] [6] [7] [8] [9] [10]. Furthermore, medication nonadherence has been linked to increased health care visits, services, and costs [11] [12] [13] [14] [15]. Studies linking nonadherence to these unfavorable outcomes have used various operational definitions for adherence—each with its own nomenclature (e.g., persistence), several representing similar if not exact components of medication adherence [2] [13] [16]. "
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    ABSTRACT: Positive associations between medication adherence and beneficial outcomes primarily come from studying filling/consumption behaviors after therapy initiation. Few studies have focused on what happens before initiation, the point from prescribing to dispensing of an initial prescription. Our objective was to provide guidance and encourage high-quality research on the relationship between beneficial outcomes and initial medication adherence (IMA), the rate initially prescribed medication is dispensed. Using generic adherence terms, an international research panel identified IMA publications from 1966 to 2014. Their data sources were classified as to whether the primary source reflected the perspective of a prescriber, patient, or pharmacist or a combined perspective. Terminology and methodological differences were documented among core (essential elements of presented and unpresented prescribing events and claimed and unclaimed dispensing events regardless of setting), supplemental (refined for accuracy), and contextual (setting-specific) design parameters. Recommendations were made to encourage and guide future research. The 45 IMA studies identified used multiple terms for IMA and operationalized measurements differently. Primary data sources reflecting a prescriber's and pharmacist's perspective potentially misclassified core parameters more often with shorter/nonexistent pre- and postperiods (1-14 days) than did a combined perspective. Only a few studies addressed supplemental issues, and minimal contextual information was provided. General recommendations are to use IMA as the standard nomenclature, rigorously identify all data sources, and delineate all design parameters. Specific methodological recommendations include providing convincing evidence that initial prescribing and dispensing events are identified, supplemental parameters incorporating perspective and substitution biases are addressed, and contextual parameters are included. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
    Value in Health 05/2015; 18(5). DOI:10.1016/j.jval.2015.02.015 · 3.28 Impact Factor
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    • "Medication adherence is defined as the patient's decision to accept and follow the instructions for taking the prescribed medication [1] [2]. In the setting of chronic medical conditions such as hypertension and hypercholesterolemia, poor MA leads to worse medical treatment outcomes, higher hospitalization rates, and increased health care costs [3] [4]. Because of this, adherence has "
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    ABSTRACT: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05). Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. MI is a patient-centered approach that can be used to improve medication adherence in primary care. This trial is registered at (NCT01291966). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Patient Education and Counseling 03/2015; DOI:10.1016/j.pec.2015.03.008 · 2.20 Impact Factor
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    • "However, this leads to two large orders of consequences: individuals' life improvement and entire community benefits thanks to better socio-health societal (Sokol et al., 2005; Leal et al., 2006). "
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    ABSTRACT: The purpose of the paper is to understand the transition from technological innovation to social innovation, analyzing insights from the biomedical context. Specifically, the study investigates how entrepreneurs manage such transition mainly referring to their motivations and awareness about social innovation. The study adopts a qualitative approach, in the form of multiple case studies of Italian firms that produce and use 3D Printing in biomedical field. Data were collected by in-depth interviews with entrepreneurs, backed by available documentary evidence and observation. Similarities and differences between the sets of findings were identified and analyzed, and conclusions drawn. The study points to the need for further investigation providing researchers with new information about the transition from technology innovation to social innovation. The transition has been studied from an exploratory perspective, considering 3D Printing as a recent phenomenon in biomedical field.
    EURAM Conference Warsaw 2015; 03/2015
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