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Do Medical Homes Increase Medication Adherence for Persons With Multiple Chronic Conditions?

Beadles, Christopher A., MD, PhD*,†,‡; Farley, Joel F., PhD§; Ellis, Alan R., PhD, MSW; Lichstein, Jesse C., PhD; Morrissey, Joseph P., PhD†,‡; DuBard, C. Annette, MD, MPH‡,∥; Domino, Marisa E., PhD†,‡

doi: 10.1097/MLR.0000000000000292
Original Articles
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Background: Medications are an integral component of management for many chronic conditions, and suboptimal adherence limits medication effectiveness among persons with multiple chronic conditions (MCC). Medical homes may provide a mechanism for increasing adherence among persons with MCC, thereby enhancing management of chronic conditions.

Objective: To examine the association between medical home enrollment and adherence to newly initiated medications among Medicaid enrollees with MCC.

Research Design: Retrospective cohort study comparing Community Care of North Carolina medical home enrollees to nonenrollees using merged North Carolina Medicaid claims data (fiscal years 2008–2010).

Subjects: Among North Carolina Medicaid-enrolled adults with MCC, we created separate longitudinal cohorts of new users of antidepressants (N=9303), antihypertensive agents (N=12,595), oral diabetic agents (N=6409), and statins (N=9263).

Measures: Outcomes were the proportion of days covered (PDC) on treatment medication each month for 12 months and a dichotomous measure of adherence (PDC>0.80). Our primary analysis utilized person-level fixed effects models. Sensitivity analyses included propensity score and person-level random-effect models.

Results: Compared with nonenrollees, medical home enrollees exhibited higher PDC by 4.7, 6.0, 4.8, and 5.1 percentage points for depression, hypertension, diabetes, and hyperlipidemia, respectively (P’s<0.001). The dichotomous adherence measure showed similar increases, with absolute differences of 4.1, 4.5, 3.5, and 4.6 percentage points, respectively (P’s<0.001).

Conclusions: Among Medicaid enrollees with MCC, adherence to new medications is greater for those enrolled in medical homes.

*RTI International Durham, NC

Department of Health Policy and Management, UNC Gillings School of Global Public Health

Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

§Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill

Community Care of North Carolina, Raleigh, NC

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This work was supported by grant R24 HS019659-01 from the Agency for Healthcare Research and Quality (AHRQ) and North Carolina Community Care Networks and by AHRQ grant 5T32-HS000032. Additional funding for Dr Beadles was provided by grant TPP 21-023 from the U.S. Department of Veterans Affairs Office of Academic Affiliations and for Dr Lichstein by grant 2T32NR008856 from the National Institute of Nursing Research.

J.F.F. has received consulting support from Daiichi Sankyo and Takeda Pharmaceutical Company for unrelated studies. A.R.E. has received research funding from Amgen, Merck, and the UNC Center for Pharmacoepidemiology for unrelated projects. M.E.D. also receives funding from AccessCare for evaluation projects unrelated to the present manuscript. C.A.D. is employed by NCCCN. The remaining authors declare no conflict of interest.

Reprints: Christopher A. Beadles, MD, PhD, 3040 E Cornwallis Rd, Durham, NC 27709. E-mail: cbeadles@rti.org.

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