Improved medication adherence reduce health care use and costs

The study, "Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending," was released in the January issue of Health Affairs. The pharmacy and medical claims data of 135,000 patients with congestive heart failure, diabetes, hypertension and dyslipidemia were analysed to determine the direct effect of medication adherence on health care costs.

Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA.: Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff (Millwood). 2011 Jan;30(1):91-9.

Abstract

Researchers have routinely found that improved medication adherence-getting people to take medicine prescribed for them-is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.

Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark said about the results of the study: „The annual per person savings for chronically ill patients who were adherent to medications compared to those who were not amounted to $7,823 for those with congestive heart failure, $3,756 for a diabetes patient, $3,908 for hypertension and $1,258 for dyslipidemia or high cholesterol. Across all conditions, adherence was associated with significantly lower annual inpatient hospital days."

"No matter what the intervention, the researchers agreed that actively encouraging medication adherence for chronic disease should be a top priority," noted M. Christopher Roebuck, director of strategic research for CVS Caremark and lead author of the study. "Despite higher pharmacy spending the reduction in hospitalizations and emergency room use resulted in substantial savings."

This study highlighted that there is a clear need for effective adherence-enhancing interventions to improve patient outcomes and/or reduce health-care costs.

Human Dynamics

I've just finished the book ”Bursts: The Hidden Pattern Behind Everything We Do” by Barabasi. Great reading, I really enjoyed it! And why is my blog about this book?

Albert-Laszlo Barabasi is one of the world's preeminent researchers on the science of networks. ”Bursts” opens a door into the human dynamics. Before reading the book your life may look random to you. But everything from your visits to a web page to your mobile phone calls are predictable, and happen in bursts.

Human dynamics is a new branch of complex systems research in statistical physics. Its main goal is to apply the powerful conceptual toolbox developed by Physicists to study the natural world to the study of human behavior. (Wikipedia)

What about adherence, is it also predictable with a mathematical formula?

Definitions: adherence, compliance, persistence, concordance

The definitions of the patient co-operation are not uniformed. This causes many difficulties when comparing the results of the studies. I searched the net and I found some good summaries about the meaning of adherence, compliance, concordance, persistence etc.

As follows adherence, compliance, persistence are defined based on the classifications of WHO, NICE, ISPOR and ABC.

WHO

Adherence: the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. 

NICE

Adherence: ‘the extent to which the patient’s behaviour matches agreed recommendations from the prescriber’. Adherence emphasises the need for agreement and that the patient is free to decide whether or not to adhere to the prescriber’s recommendation.

Concordance: this is a recent term whose meaning has changed. It was initially applied to the consultation process in which prescriber and patient agree therapeutic decisions that incorporate their respective views, but now includes patient support in medicine-taking as well as prescribing communication. Concordance reflects social values but does not address medicine-taking and may not lead to improved adherence.

Persistence: The length of time from initiation to discontinuation of therapy.

ISPOR
Medication compliance (synonym: adherence): refers to the degree or extent of conformity to the recommendations about day-to-day treatment by the provider with respect to the timing, dosage, and frequency. It may be defined as “the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen.”

Medication persistence: refers to the act of continuing the treatment for the prescribed duration. It may be defined as “the duration of time from initiation to discontinuation of therapy.” Persistence analyses must include a prespecified limit on the number of days allowed between refills, considered the “permissible gap.”

ABC

Medication adherence: is the process by which patients take their medication as prescribed. It consists of three parts:

Initiation: occurs when the patient takes the first dose of the prescribed medication.

Discontinuation: occurs when the patient stops taking the prescribed medication.

Execution: patients’ accuracy in following the day-to-day dosing regimen while still actively taking the medication. It is the multidimensional outcome of the comparison of two time series: the prescribed drug dosing regimen and the patient’s drug dosing history while he or she is still engaged with treatment. Evaluation is disease/treatment specific.

Persistence: the length of time that the patient continues to be engaged with the prescribed dosing regimen.

Medication adherence is best quantified using two parameters: execution and persistence.

Medication therapy management: The overall process of assisting patients in the initiation and conduct of their drug therapies.

Adherence-Related Behavioral Science: the many disciplines concerned with patients’ and providers’ decision-making, acceptance of, and ability to effectively adhere to a medication regimen.

Pharmionics: The discipline concerned with the quantitative assessment of what patients do with prescribed medicines. It is concerned with the study of how prescribed medications are used by ambulatory patients. Pharmionics (ion=to go) means “the going of the pharmaceutical(s)” and constitutes thus a link to the biomedical field as a natural input to pharmacokinetic and pharmacodynamic models for quantitative analysis of pharmacometric and economic consequences of dosing errors.