Do medical homes increase medication adherence for persons with multiple chronic conditions?

Autor:	Beadles CA; RTI International Durham, NC †Department of Health Policy and Management, UNC Gillings School of Global Public Health ‡Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill §Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill ∥Community Care of North Carolina, Raleigh, NC., Farley JF, Ellis AR, Lichstein JC, Morrissey JP, DuBard CA, Domino ME
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2015 Feb; Vol. 53 (2), pp. 168-76.
DOI:	10.1097/MLR.0000000000000292
Abstrakt:	Background: Medications are an integral component of management for many chronic conditions, and suboptimal adherence limits medication effectiveness among persons with multiple chronic conditions (MCC). Medical homes may provide a mechanism for increasing adherence among persons with MCC, thereby enhancing management of chronic conditions. Objective: To examine the association between medical home enrollment and adherence to newly initiated medications among Medicaid enrollees with MCC. Research Design: Retrospective cohort study comparing Community Care of North Carolina medical home enrollees to nonenrollees using merged North Carolina Medicaid claims data (fiscal years 2008-2010). Subjects: Among North Carolina Medicaid-enrolled adults with MCC, we created separate longitudinal cohorts of new users of antidepressants (N=9303), antihypertensive agents (N=12,595), oral diabetic agents (N=6409), and statins (N=9263). Measures: Outcomes were the proportion of days covered (PDC) on treatment medication each month for 12 months and a dichotomous measure of adherence (PDC>0.80). Our primary analysis utilized person-level fixed effects models. Sensitivity analyses included propensity score and person-level random-effect models. Results: Compared with nonenrollees, medical home enrollees exhibited higher PDC by 4.7, 6.0, 4.8, and 5.1 percentage points for depression, hypertension, diabetes, and hyperlipidemia, respectively (P's<0.001). The dichotomous adherence measure showed similar increases, with absolute differences of 4.1, 4.5, 3.5, and 4.6 percentage points, respectively (P's<0.001). Conclusions: Among Medicaid enrollees with MCC, adherence to new medications is greater for those enrolled in medical homes.
Databáze:	MEDLINE
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