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Medical homes associated with better medication adherence

Patients who receive care for common chronic diseases in patient-centered medical homes are more likely to adhere to their medication regimen as prescribed, according to findings published in Annals of Internal Medicine.

“Because poor medication adherence is strongly associated with worse patient outcomes and high health care spending, it is viewed as a key measure of quality of care by major organizations,” Julie C. Lauffenburger, PharmD, PhD, from Brigham and Women’s Hospital, and colleagues wrote. “However, it has not been evaluated in primary care practices that meet recognition criteria for patient-centered medical homes.”

Lauffenburger and colleagues conducted a retrospective cohort study of a large national sample of patients (n = 313,765) to determine whether care in patient-centered medical homes impacted compliance with prescribed regimens. Adherence to medications for chronic diseases such as diabetes, hypertension and hyperlipidemia between 2011 and 2013 in both patient-centered medical homes recognized by the National Committee for Quality Assurance (n = 18,611, 5.9%) and propensity score-matched control practices (n = 4,660) in the same Primary Care Service Areas was measured and compared using linear mixed models. 

Data indicated that patients who received care in patient-centered medical homes had a higher mean adherence rate compared to patients who received care in control practices (64% vs. 59%) with an absolute difference of 2.2%. There was no significant difference in better adherence to medications in medical homes between patients with diabetes, hypertension and hyperlipidemia.

“Patients using [National Committee for Quality Assurance]-recognized patient-centered medical homes seem to have better adherence to newly initiated chronic disease medications than patients using other practices,” Lauffenburger and colleagues concluded. “Medical homes were shown to lead to significantly better medication adherence, a vital measure of health care quality for chronic diseases. These findings have significant implications for providers, health plans, and policymakers who are considering the best potential practices for patients.”

In an accompanying editorial, Michele Heisler, MD, MPA, from the University of Michigan and VA Ann Arbor Healthcare System, wrote that this study expands prior assessment of medication adherence in patient-centered medical homes by using a population from a national sample, more vigorous methods and well-validated claims-based measures.

“The next step will be to examine what specific features of patient-centered medical homes are most critical for improving patients' medication adherence, overall self-management, and associated clinical outcomes,” she wrote. “Patient-centered medical home initiatives are highly heterogeneous, and some designs and approaches will be more successful than others. Adherence is a complex phenomenon; effective approaches must be tailored to meet individual patients' needs and preferences.” – by Alaina Tedesco

Disclosure: Lauffenburger and colleagues report primary funding by CVS Health. Heisler reports no relevant financial disclosures.