Julie C. Lauffenburger, PharmD, PhD; William H. Shrank, MD, MSHS; Asaf Bitton, MD, MPH; Jessica M. Franklin, PhD; Robert J. Glynn, PhD; Alexis A. Krumme, MS; Olga S. Matlin, PhD; Edmund J. Pezalla, MD, MPH; Claire M. Spettell, PhD; Gregory Brill, MS; Niteesh K. Choudhry, MD, PhD
Grant Support: By an unrestricted grant from CVS Health to Brigham and Women's Hospital.
Disclosures: Dr. Lauffenburger reports a grant from CVS Health during the conduct of the study. Dr. Shrank reports personal fees from Johnson & Johnson outside the submitted work and employment with CVS Health at the time of this work. Dr. Bitton reports a consultancy for the Center for Medicare and Medicaid Innovation; employment with Brigham and Women's Hospital, Ariadne Labs; and grants from the Bill & Melinda Gates Foundation and World Bank Group outside the submitted work. Dr. Glynn reports grants from Novartis and Pfizer outside the submitted work. Ms. Krumme reports a grant from CVS Health during the conduct of the study. Dr. Matlin reports employment with and stock ownership in CVS Health. Dr. Spettell reports employment with Aetna outside the submitted work. Dr. Choudhry reports grants from CVS Caremark during the conduct of the study and from Sanofi; AstraZeneca; Medisafe; the National Heart, Lung, and Blood Institute; Merck; and Pharmaceutical Research and Manufacturers of America outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2659.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Choudhry (e-mail, firstname.lastname@example.org). Statistical code: Not available. Data set: Available to approved persons through written agreements with the authors and the data partner.
Requests for Single Reprints: Niteesh K. Choudhry, MD, PhD, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120; e-mail, email@example.com.
Current Author Addresses: Drs. Lauffenburger, Franklin, Glynn, and Choudhry; Ms. Krumme; and Mr. Brill: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120.
Drs. Shrank and Matlin: CVS Health, 1 CVS Drive, Woonsocket, RI 02895.
Dr. Bitton: Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215.
Drs. Pezalla and Spettell: Aetna, 151 Farmington Avenue, Hartford, CT 06156.
Author Contributions: Conception and design: J.C. Lauffenburger, W.H. Shrank, A. Bitton, N.K. Choudhry.
Analysis and interpretation of the data: J.C. Lauffenburger, W.H. Shrank, A. Bitton, J.M. Franklin, R.J. Glynn, O.S. Matlin, E.J. Pezalla, C.M. Spettell, G. Brill, N.K. Choudhry.
Drafting of the article: J.C. Lauffenburger, A. Bitton, E.J. Pezalla, N.K. Choudhry.
Critical revision of the article for important intellectual content: W.H. Shrank, A. Bitton, J.M. Franklin, R.J. Glynn, A.A. Krumme, O.S. Matlin, E.J. Pezalla, N.K. Choudhry.
Final approval of the article: J.C. Lauffenburger, W.H. Shrank, A. Bitton, J.M. Franklin, R.J. Glynn, A.A. Krumme, O.S. Matlin, E.J. Pezalla, C.M. Spettell, G. Brill, N.K. Choudhry.
Provision of study materials or patients: W.H. Shrank, N.K. Choudhry.
Statistical expertise: J.C. Lauffenburger, W.H. Shrank, J.M. Franklin, R.J. Glynn, N.K. Choudhry.
Obtaining of funding: O.S. Matlin, N.K. Choudhry.
Administrative, technical, or logistic support: J.C. Lauffenburger, W.H. Shrank, A. Bitton, A.A. Krumme, O.S. Matlin, G. Brill.
Collection and assembly of data: J.C. Lauffenburger, W.H. Shrank, C.M. Spettell, N.K. Choudhry.
Despite the widespread adoption of patient-centered medical homes into primary care practice, the evidence supporting their effect on health care outcomes has come primarily from geographically localized and well-integrated health systems.
To assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending.
Retrospective cohort study.
Claims from a large national health insurer.
Patients initiating therapy with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013.
Medication adherence in the 12 months after treatment initiation was compared among patients cared for by providers practicing in National Committee for Quality Assurance–recognized patient-centered medical homes and propensity score–matched control practices in the same Primary Care Service Areas. Linear mixed models were used to examine the association between medical homes and adherence.
Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. Among 4660 matched control and medical home practices, medication adherence was significantly higher in medical homes (2.2% [95% CI, 1.5% to 2.9%]). The association between medical homes and better adherence did not differ significantly by disease state (diabetes, 3.0% [CI, 1.5% to 4.6%]; hypertension, 3.2% [CI, 2.2% to 4.2%]; hyperlipidemia, 1.5% [CI, 0.6% to 2.5%]).
Clinical outcomes related to medication adherence were not assessed.
Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases.
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Lauffenburger JC, Shrank WH, Bitton A, Franklin JM, Glynn RJ, Krumme AA, et al. Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study. Ann Intern Med. 2017;166:81-88. doi: 10.7326/M15-2659
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Published: Ann Intern Med. 2017;166(2):81-88.
Published at www.annals.org on 15 November 2016
Cardiology, Coronary Risk Factors, Diabetes, Dyslipidemia, Endocrine and Metabolism.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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