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SOP Partners with PhRMA to Publish New Medication Adherence Chartbook

Improper use of and non-adherence to evidence-based medications remain leading causes of poor outcomes and increased health care costs for many Medicare beneficiaries with diabetes, heart failure, and COPD.

By Malissa Carroll
March 4, 2014

Bruce Stuart, PhD, professor in the Department of Pharmaceutical Health Services Research (PHSR) and director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy, has partnered with Pharmaceutical Research and Manufacturers of America (PhRMA) to publish Medication Utilization Patterns and Outcomes Among Medicare Part D Enrollees with Common Chronic Conditions, a chartbook that analyzes trends in medication adherence among Medicare beneficiaries diagnosed with at least one of three chronic illnesses – diabetes, heart failure, and chronic obstructive pulmonary disease (COPD) – who were enrolled in a stand-alone Part D prescription drug plan from 2006 to 2008.

“From 2006 to 2008, approximately half of all Medicare beneficiaries who were enrolled in a Part D prescription drug plan were diagnosed with diabetes, heart failure, and/or COPD,” says Stuart. “However, while there is substantial research that demonstrates the critical role that evidence-based medications play in maintaining patients’ health and reducing the risk of future complications, this chartbook shows that patients’ use and adherence to these medications is poor and continues to decline over time.”

Among the sample of Medicare beneficiaries studied in the chartbook taken from Jan. 1, 2006 to Dec. 31, 2008 – including 122,825 beneficiaries with diabetes, 91,612 with heart failure, and 76,446 with COPD — only 55-65 percent of patients with diabetes and heart failure were prescribed evidence-based medications to treat their disease. For patients with COPD, the percentage decreased to 27-39 percent. Among those patients who were prescribed those recommended medications, annual adherence rates were poor, with 65-75 percent adherence among patients with diabetes and heart failure and 25-50 percent adherence for patients with COPD.

However, additional findings published in the chartbook show that the most consistent predictor of adherence was the number of chronic, or long-term, medications in the patient’s medication regimen. Patients who took 10 or more medications showed adherence rates of 80 percent or more, compared to adherence rates of 56-67 percent for patients who took three or fewer medications.

“As a practicing pharmacist who works primarily with older adults, I have seen medication adherence be influenced by many factors,” says Nicole Brandt, PharmD, CGP, BCPP, FASCP, associate professor in the Department of Pharmacy Practice and Science (PPS) and director of clinical and educational programs at the Peter Lamy Center on Drug Therapy and Aging. “Often, I see patients who have been taking many medications for several years tend to be more adherent to their medication regimen.”

She adds, “Based on my experience, part of the reason for this behavior is that these patients often have set up a support or reminder system to help them manage their medications. In addition, they understand the importance of remaining adherent to their medications to effectively manage their chronic conditions, including diabetes and heart failure, and reduce their risk of hospitalization.”

Researchers also found a number of benefits associated with better adherence. Patients who remained adherent to their medications often experienced better outcomes, including a reduction in the number of preventable hospitalizations. Improved medication adherence was also associated with a significant decrease in Medicare spending on hospital and other medical services for patients with diabetes and heart failure.

“The data presented in this chartbook clearly demonstrate the value that medicines can deliver to Medicare Part D beneficiaries and the health care system,” says Samantha Dougherty, PhD, director of PhRMA and one of the chartbook’s authors. “When patients adhere to their medications, clinical outcomes improve, avoidable hospitalizations decrease, and a reduction in health care spending occurs.”

However, determining what measures health care professionals can take to improve patients’ medication adherence is no easy task for health services researchers like Stuart. “Increasing patients’ adherence to their medications should be a major policy objective. To me, the key to accomplishing this objective is good communication between the health care provider and the patient, though how we enforce or assure that communication takes place is not clear at this time,” he says.

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