Patients receiving care in patient-centered medical homes may have better long-term adherence to newly initiated chronic disease medications than those in other practices, a recent study found.
Along with administrative claims data from Aetna, researchers used propensity score matching to compare patients' medication adherence between 2,330 medical homes recognized by the National Committee for Quality Assurance and 2,330 control practices. Results of the study, funded by CVS Health, were published online on Nov. 14 by Annals of Internal Medicine.
The matched cohort contained 11,636 medical home patients and 10,117 control practice patients, all of whom started new medications between 2011 and 2013. Optimal adherence was defined as 80% or more days covered during the 12 months after initiation of medications for 1 of 3 conditions: hypertension, diabetes, or hyperlipidemia.
One year after treatment initiation, 43.9% of medical home patients were optimally adherent, compared to 37.6% of control patients. Absolute rates of adherence were 2.2% (95% CI, 1.5% to 2.9%) higher among medical home patients than control patients. The unadjusted mean proportion of days covered was 64% among medical home patients, compared to 59% among control patients.
The effect of a medical home on adherence was similar across medication classes and initiation years, with a slightly higher effect among patients starting medications for diabetes (3.0%; 95% CI, 1.5% to 4.6%) and hypertension (3.2%; 95% CI, 2.2% to 4.2%) than among those starting cholesterol-lowering medications (1.5%; 95% CI, 0.6% to 2.5%).
The authors noted limitations to the cross-sectional study, such as how it was based on administrative data and limited to commercially insured patients. In addition, they did not assess clinical outcomes or the potential impact of specific features of medical homes.
An accompanying editorial also questioned whether the observed 2% improvement in adherence is clinically significant. “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,” the editorialist wrote.