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Advancing the Science and Practice of Medication Adherence. Medication adherence remains a significant unmet challenge for optimizing patient outcomes. Recent advances in the conceptualization, measurement, and support of medication adherence offer fresh opportunities to make a meaningful impact on adherence-related behavior and outcomes.
Mathews et al. Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study. Am Heart J. 2015 Jul;170(1):62-9. doi: 10.1016/j.ahj.2015.03.019. Nearly one-third of heart attack patients are no longer persistent with their prescribed medications by 6 months.
Comer et al. Using Aggregated Pharmacy Claims to Identify Primary Nonadherence. Am J Manag Care. 2015;21(12):e655-e660. Using aggregated pharmacy claims data available within electronic health records, two-thirds of patients prescribed antihypertensive medications were observed filling the prescription within 30 days.
Adherence to Psychotropic and Nonpsychotropic Medication Among Patients With Bipolar Disorder and General Medical Conditions. Jennifer B. Levin, Ph.D., Michelle E. Aebi, M.A., Curtis Tatsuoka, Ph.D., Kristin A. Cassidy, M.A., Martha Sajatovic, M.D. Psychiatric Services, 2015. Psychotropic adherence was worse than non-psychotropic adherence, yet both were poor. Improving adherence to cardiovascular medications is a reasonable pathway to improve cardiovascular health in this population.
Role of Coverage and Cost Sharing on Adherence
Current evidence indicates that higher specialty drug cost sharing is associated with reduced specialty drug utilization. Evidence to date generally indicates reductions in specialty drug utilization associated with higher cost sharing; effects have varied by type of disease and specialty drug use outcome. There remains a critical need for methodologically rigorous research to further evaluate whether the aggressive cost sharing arrangements may cause patients to forego, delay, or decrease adherence to specialty drugs, and whether that results in poor health outcomes and higher total spending.
This a retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. The study found that high cost sharing was associated with reduced and/or delayed initiation of tyrosine kinase inhibitors (TKIs), a class of targeted specialty drugs. Policy strategies are discussed to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.
Emergence and Impact of Pharmacy Deductibles: Implications for Patients in Commercial Health Plans. IMS Health recently published a study showing that the share of commercial plans requiring a deductible for prescription drugs doubled between 2012 and 2015, increasing from 23% to 46%. The report suggests that patients enrolled in plans with drug deductibles have higher prescription abandonment and lower adherence rates than those enrolled in plans without drug deductibles.
Value of Adherence
Economic analysis shows that use of an automated voice messaging system to promote adherence to ACEIs/ARBs and statins may be cost-effective.
Y Jiang et al. Estimating the Impact of Adherence to and Persistence with Atypical Antipsychotic Therapy on Health Care Costs and Risk of Hospitalization.Pharmacotherapy, 35: 813–822. doi: 10.1002/phar.1634. Using Humana health care insurance database from 2007 to 2013, adherence was shown to be associated with decreased total costs by $19,497 (p<0.05), increased medication costs by $8194 (p<0.001), decreased medical services costs by $27,664 (p<0.001), and reduced hospitalization risk by 27% (p<0.001). Being persistent decreased individual total costs by $23,927 (p<0.05), increased medication costs by $10,278 (p<0.001), and decreased medical services costs by $34,178 (p<0.001). We could not identify a significant association between persistence and the risk of hospitalization.
Stuart, B. C., Dai, M., Xu, J., E Loh, F. H., & S Dougherty, J. (2015). Does good medication adherence really save payers money?. Medical care, 53(6), 517-523. Just over half of Part D enrollees with diabetes exhibit good adherence, which was associated with nearly $5,000 in reduced medical spending and $4,000 in reduced total Medicare (including drug) spending for select therapeutic areas over two years.
Bitton, A., Choudhry, N. K., Matlin, O. S., Swanton, K., & Shrank, W. H. (2013). The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. The American journal of medicine, 126(4), 357-e7. High adherence to treatment of coronary artery disease significantly improves health outcomes and reduces costs by 10%-18% or costs between $294 and $868 per patient.
Quittner, A. L., Zhang, J., Marynchenko, M., Chopra, P. A., Signorovitch, J., Yushkina, Y., & Riekert, K. A. (2014). Pulmonary medication adherence and health-care use in cystic fibrosis. CHEST Journal, 146(1), 142-151. Patients with CF who have poor adherence to pulmonary medications experience about 35% more hospitalizations and $14,211 greater healthcare costs over one year compared to highly adherent patients.
Wei, Y. J., Palumbo, F. B., Simoni-Wastila, L., Shulman, L. M., Stuart, B., Beardsley, R., & Brown, C. H. (2014). Antiparkinson drug adherence and its association with health care utilization and economic outcomes in a Medicare Part D population. Value in Health, 17(2), 196-204. In this nationally representative sample, higher adherence to APDs and longer duration of use of APDs were associated with lower all-cause health care utilization and total health care expenditures. Our findings suggest the need for improving medication-taking behaviors among patients with PD to reduce the use of and expenditures for medical resources.
Feldman, C. H., Yazdany, J., Guan, H., Solomon, D. H., & Costenbader, K. H. (2015). Medication nonadherence is associated with increased subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus. Arthritis care & research. Patients with Lupus had 55% increased rates of ED use and 37% increased rates of hospitalizations when not adherent to their therapy.
Congressional Budget Office. “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Service.” November 2012. The Congressional Budget Office accounts for the beneficial impact of prescription medicine use in the scoring methodology. The new methodology assumes that a 1% increase in number of prescriptions filled results in a 0.20% decrease in spending on medical services in Medicare.
Jha, et al. “Greater Adherence to Diabetes Drugs is Linked to Less Hospital Use and Could Save Nearly $5 Billion Annually.” Health Affairs 31 no. 8 (2012): 1836-46. Improved medication adherence among patients with diabetes could result in over 1 million avoided emergency department visits and hospitalizations annually, for potential savings of $8.3 billion each year.
Impact of Adherence Strategies
Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial Asch DA, Troxel AB, Steward WF, Sequist TD, Jones JB, Hirsch AG, Hoffer K, Zhu J, Wang W, Hodlofski A, Frasch AB, Weiner MG, Finnerty DD, Rosenthal MB, Gangemi K, Volpp KG. JAMA. 2015;314(18):1926-1935. In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value.
Do Medical Homes Increase Medication Adherence for Persons with Multiple Chronic Conditions? Beadles CA, Farley JF, Ellis AR, Lichstein JC, Morrissey JP, DuBard CA et al. MedCare. 2015; 53(2): 168-76. Medical home enrollees exhibit better adherence than non-enrollees for depression, hypertension, diabetes, and hyperlipidemia treatment.