Patient-Centered Medical Homes May Improve Diabetes Care

Patient-centered medical homes (PCMHs) may improve the performance of process measures of care for patients with type 2 diabetes, including glycated hemoglobin (A1c) tests, cholesterol tests, foot examination, dilated eye examination, flu vaccination, and adherence to oral hypoglycemic agents (OHAs) during 1 year of follow-up, according to a study in Journal of Managed Care & Specialty Pharmacy by JaeJin An, BPharm, PhD, of the Department of Pharmacy Practice and Administration at Western University of Health Sciences College of Pharmacy.

The PCMH is a model that emphasizes primary care physicians, who are responsible for leading interdisciplinary teams and encouraging cooperation and collaboration between providers and patients. The model provides a potential mechanism for improving medication adherence through enhanced coordination, case management, medication reconciliation, as well as shared decision making and enhanced access to care. The literature on PCMHs has reported positive effects on preventive care services, such as cancer screening and vaccinations, but results are mixed regarding quality of care, and there is little evidence that the PCMH model reduces visits to the emergency department or produces cost savings from PCMH interventions.

In this study, An used longitudinal data from 2009 to 2013 from the Medical Expenditure Panel Survey, in which 3334 adult patients with diabetes were identified. Approximately 11.4% of the patients were categorized as the PCMH group at baseline, and only 3.6% of those patients remained in the PCMH group for 2 years. Of the patients with diabetes who were identified, only 26.9% met all of the diabetes care process measure criteria of the study. A higher proportion met process measure criteria in the PCMH group versus the non-PCMH group (33.8% vs 26%, respectively; P = .015). Measures of adherence to medication for OHAs in the 2 groups were not statistically different, resulting in a finding that 47.4% of patients in the study population were adherent to medications.

Overall, the PCMH group was associated with improvement in the process measures of diabetes care (adjusted odds ratios = 1.42; 95% CI, 1.06-1.91) and the effect was greater among the patients who stayed in the PCMH group for 2 years, were younger than 65 years of age, or had fewer than 3 comorbid conditions. But being in the PCMH group was not associated with an increased adherence to OHAs.

The study concluded that the PCMH model was associated with improvement in process measures of diabetes care mainly because of increased rate of dilated eye examination.

“Enhanced shared decision making and patient engagement features of the PCMH model likely influenced these findings,” An wrote. “The effect of PCMHs seems to be greater in younger populations, as well as patients with fewer comorbid conditions.”

Future studies should investigate the mechanism of PCMHs in overall quality of care, as well as medication adherence.