Article

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: 10.1097/01.mlr.0000163641.86870.af
Source: PubMed

ABSTRACT

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
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    • "A study indicated that the therapeutic effect of a drug depends not only on patients having the treatment prescribed but also on their adherence to or compliance with the treatment [8]. Moreover, does drug treatment reduce overall health care costs by reducing patients' need for expensive medical services such as hospitalization and emergency room (ER) treatment [3]? It is also critical to look at this issue in detail. "
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    ABSTRACT: Aim . Good medication adherence may decrease the probability of worse outcomes and reduce unnecessary medical care costs. This study aims to evaluate medication adherence for people on statin therapy. Methods . National health insurance databases were analyzed from January 1, 2001, to December 31, 2007. Study samples were patients of 45 years and older adults who took statin for the first time during the study period. Medication possession ratio (MPR) was measured until the patients had hospitalization or reached the three-year follow-up period. We identified a good (MPR ≥ 80%) and a poor (MPR < 80%) medication adherence group to conduct statistical analyses. Results. 40.8% of patients were of good medication adherence and 59.2% were of poor medication adherence. Multivariate logistic regression model indicated that the MPR ≥ 80% group had significantly less probability of hospitalization ( P < 0.001 ). Being men, increasing age, higher Charlson Comorbidity Index (CCI) scores, seeking care mostly in the medical center or teaching hospitals, and living in the suburban or rural areas had higher probability of hospitalization ( P < 0.05 or P < 0.001 ). The MPR ≥ 80% group spent less hospitalization expenditures ( P < 0.001 ). Conclusion. Effective interventions may be applied to the poor medication adherence group in order to improve their health care outcomes.
    Full-text · Article · Oct 2015
    • "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.
    No preview · Article · May 2015 · Value in Health
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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 ClinicalTrials.gov (NCT01291966). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Patient Education and Counseling
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