Managed Care - February 2008 - (Page 48) In Chronic Disease, Nationwide Data Show Poor Adherence by Patients to Medication And by Physicians to Guidelines A widespread approach that incorporates various stakeholders may be necessary to change adherence behavior Sara L. Thier, MPH1, Kristina S. Yu-Isenberg, PhD, MPH, RPh2, Brian F. Leas, MS, MA3, C. Ron Cantrell, PhD2, Sandra DeBussey2, Neil I. Goldfarb3, and David B. Nash, MD, MBA3 Medical Communications Media, Newtown, Pa.; 2Glaxo-SmithKline, Philadelphia, Pa.; 3Thomas Jefferson University, Philadelphia, Pa. 1 ABSTRACT Purpose: It is widely acknowledged in small studies that provider variation from evidence-based care guidelines and patient medication nonadherence lead to less than optimal health outcomes, increasing costs, and higher utilization. The research presented here aims to determine the prevalence of patient adherence to a medication regimen and provider adherence to guidelines for a variety of chronic conditions, using nationally representative data. Design: A retrospective analysis of administrative claims data from a large national insurer was conducted. Methodology: The study examined multiple quality indicators exemplifying evidence-based medicine and medication adherence for Corresponding author: Sara L. Thier, MPH Senior Medical Writer/Editor Medical Communications Media 54 Friends Lane, Suite 125 Newtown, PA 18940 Phone: 609-937-1282 slt1965@aol.com several chronic conditions. Medication possession ratio (MPR) determined patient adherence. Using EBM Connect software created by Ingenix, we measured adherence to guidelines by applying a series of clinical rules and algorithms. Principal findings: Adherence to the evidence-based practice guidelines examined in this study averaged approximately 59 percent, while patient medication nonadherence rates for all the conditions studied averaged 26.2 percent, with a range of 11 percent to 42 percent. Physician adherence to guidelines was highest in the prescribing of inhaled corticosteroids for persistent asthma. Ironically, medication adherence rates for inhaled corticosteroids were the worst identified. The best medication adherence rate was observed in patients with hypertension. Conclusion: Like earlier studies, this analysis finds that poor adherence is common across the nation and across common chronic conditions. INTRODUCTION It is widely acknowledged that variations in care and poor compliance with evidence-based care guidelines lead to less than optimal health outcomes. McGlynn et al found that outpatients receive evidence-based care approximately 50 percent of the time (McGlynn 2003). More recent studies demon- Disclosure: This study was supported by GlaxoSmithKline, which was involved in the design of the research question, acquisition of data, and review of the manuscript. GSK was not involved in the design and implementation of the analysis or the evaluation of results. GSK supported the analysis of the data by Ingenix. The authors report these relationships that may be conflicts of interest: Sara L. Thier, MPH, reports no conflicts. David B. Nash, MD, MBA, chairman of the Department of Health Policy at Thomas Jefferson University, reports that he is a board member of Itrax and Informedix. Brian F. Leas, MS, MA and Neil I. Goldfarb, in the Department of Health Policy at Thomas Jefferson University, report no conflicts. Kristina S. Yu-Isenberg, PhD, MPH, RPh; C. Ron Cantrell, PhD, and Sandra DeBussey are employees of Glaxo SmithKline in the Health Management Innovations department. 48 MANAGED CARE / FEBRUARY 2008
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