Chronic Disease Medication Adherence Higher in Patient-Centered Medical Homes

Patients who received care for their chronic diseases in a patient-centered medical home (PCMH) had higher rates of medication adherence over 12 months compared with patients treated elsewhere, according to a study in the Annals of Internal Medicine.

The researchers identified 2330 PCMHs recognized by the National Center for Quality Assurance (NCQA), then matched them by practice characteristics with 2330 control practices to form the study cohort. Using insurance claims data, the researchers identified 21,753 patients in these practices who had initiated treatment with a hypoglycemic, antihypertensive, or cholesterol-lowering medication. They then calculated the proportion of days covered by claims to determine the rates of adherence at the patient level.

In the year after initiating treatment, 43.9% of patients treated at PCMHs were optimally adherent, defined as more than 80% of days covered, compared with 37.6% of patients in the control practices. Absolute rates of adherence, measured by proportion of days covered, were 2.2% higher among patients using medical homes than control patients.

The differences between the groups were greatest for diabetes and hypertension patients, who had 3.0% and 3.2% higher rates of adherence in PCMHs than in control practices. Among patients with hyperlipidemia, the PCMH patients had adherence rates 1.5% higher than patients in control practices.

Previous studies have shown poor adherence to be strongly associated with worse patient outcomes and higher healthcare spending, but there is little research on the association between PCMH use and medication adherence. One of the few previous studies to investigate this link was an analysis of Medicaid beneficiaries in North Carolina, which found that patients in medical homes had differences in adherence of 3% to 6% compared with control patients.

The study authors noted that there are other interventions, “such as elimination of out-of-pocket copayments, case management, and intensive behavioral support and education,” that have strong evidence supporting their effectiveness on medication adherence. The effect of the medical home model, while slightly smaller, “may nevertheless be clinically meaningful.”

To explain why medical homes could have better capacities and tools for managing chronic diseases, the study authors hypothesize that these homes “focus on enhancing and establishing patient—provider relationships, patient engagement, and quality of care, primarily through improved technology and care coordination. For recognition [by the NCQA], medical homes are also encouraged to specifically focus on management of a set of chronic diseases, notably diabetes and hypertension.”