People with common chronic diseases may be more likely to take their medication regularly when they're treated at a patient-centered practice known as a medical home, according to a new U.S. study.
Patient-centered medical homes (PCMH) coordinate care under the leadership of a primary care doctor in a centralized location. Insurance imbursement for providers is tied to the quality of care delivered.
"The idea of a patient centered medical home has been around for more than a decade," and currently more than 10 percent of all primary care practices qualify as a PCMH in the U.S., according to senior author Dr. Niteesh K. Choudhry of Brigham and Women's Hospital in Boston.
So far, the data suggests that this model improves care and reduces costs overall, though the improvements in medication adherence in this study were admittedly modest, Choudhry told Reuters Health.
The researchers analyzed claims data from the national health insurer Aetna for more than 300,000 patients initiating medication therapy for diabetes, high blood pressure or high cholesterol between 2011 and 2013.
Almost 6 percent of the sample, or 18,611 people, received care in patient-centered medical homes. Using records of prescription refills, the researchers determined how many patients were "fully adherent" to treatment, in this case meaning they had filled prescriptions regularly enough to have meds available to take 80 percent of the time.
For the 12 months after starting treatment, 44 percent of medical home patients were fully adherent to medication, compared to 38 percent of those in practices with other primary care models. Overall, medical home patients had sufficient medication to be adherent 64 percent of the time versus 59 percent for the comparison group, according to the results Annals of Internal Medicine.
After adjusting for characteristics of the patients, researchers found that for diabetes, high cholesterol and high blood pressure, adherence rates were 2 percent to 3 percent higher for medical home patients, compared to the others.
These results probably apply to similar chronic conditions like chronic obstructive pulmonary disease and osteoporosis, Choudhry said.
"In the same way that how well care is organized and delivered both in and between clinic visits can significantly influence how satisfied people are with their care, there is a lot of evidence that these characteristics significantly influence whether people fill and adhere to their prescribed medications," said Dr. Michele Heisler of the University of Michigan in Ann Arbor and VA Ann Arbor Healthcare System, who was not part of the new study.
Patient-centered medical homes often foster sustained, trusting, and collaborative relationships between providers and patients, have systems to monitor patients' levels of adherence to medications from all prescribers and identify barriers to adherence and appropriate strategies to address these, Heisler said.
They also identify patients who require higher levels of adherence support, and provide such support between face-to-face visits, all of which may improve medication adherence and outcomes, said Heisler, who wrote a commentary accompanying the study.
"There can be higher upfront costs to setting up a PCMH, such as investing in electronic health records and better monitoring and tracking systems," Heisler told Reuters Health by email. "By providing more organized and patient-centered care, the aim is that patients won't have to use Emergency Rooms or be admitted to the hospital as often, which ultimately would save money for payers and be better for patients."
But not all people in the U.S. have equal access to medical homes, she noted.
"It is worth looking for whether there are National Committee for Quality Assurance-recognized practices that have achieved PCMH status," Heisler said. "These are more likely to have systems and processes in place to be able to ensure you are getting all the screenings you need, following up on what was ordered and happened in clinic visits, better integrating care with other specialists, and extending support and communication in a proactive way beyond face-to-face clinic visits."
"I don't think we should overestimate the ability of PCMH type environments to miraculously fix nonadherence, but clearly some of what they are doing is making a positive contribution," Choudhry said.