Studies provide more clues to patient adherence, medical needs

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Patient adherence has a lot of numbers associated with it. The National Community Pharmacists Association, for example, asserts in its recent adherence report card that non-adherence adds about $290 billion a year in health-related costs, while a 2012 ExpressScripts report attributed over 250,000 hospitalizations to asthma medication non-adherence. Earlier this year the IMS Institute for Healthcare Informatics put the the avoidable cost opportunity from non-adherence at $105 billion.

A logical conclusion would be that greater adherence could drive down costs, but a study of insurance programs that lower the cost of medications based on their association with reducing death and illness found that removing financial barriers to medication adherence improves the quality of a patient's care, but does not result in a savings windfall. Nor do they put the healthcare system on the hook for massive health-related costs, according to  researchers who recently published the findings on value-based insurance plans (VBIDs)—also called evidence-based plans—in the July issue of Health Affairs.

The researchers, who studied data from 13 studies focusing on VBID plans, found that lowering prices—by eliminating or reducing co-payments, for example—was associated with higher medication use and less intense downstream effects in the form of fewer emergency room and physician visits.

As with past cost studies, this survey window was too narrow to project the long-term financial impact of lowering prices for certain treatments. Researchers note that “the primary benefit of value-based insurance design may be in its ability to improve the quality of care for patients with chronic diseases,” even though payer enthusiasm for such programs has been along the lines of seeing a financial return within one to three years.

A recent editorial by the Institute of Medicine's Harvey Fineberg, however, offered context for what the long-term impact of doing nothing can be. Published online in the Journal of the American Medical Association on Wednesday, Fineberg provided some highlights from a report by the US Burden of Disease Collaborators. In short: despite technology and medication, the US is doing a poor job of promoting patient health.

“By every measure including death rates, life expectancy, and diminished function and quality of life assessed by the authors, the US standing compared with 34 Organization for Economic Co-Operation and Development countries declined between 1990 and 2010,” he wrote.

Among the findings: heart disease, lung cancer, stroke and COPD were the four leading causes of deaths in the US from 1990 to 2010 (diabetes was seventh). Meanwhile, low back pain, major depressive disorder, musculoskeletal disorders, neck pain, anxiety disorder and COPD were among leading causes of “years lived with disability.” (Diabetes ranked eighth.) In other words, high-maintenance conditions which require adherence to medical regimens.

Adding to the data pile, and providing additional insight into how these components begin to fit together, is a third study, this time by a team led by George Washington University School of Nursing professor Jessica Greene. In this instance, researchers found that a factor called "patient activation" is a critical component to care. The term, defined in the research published in the July Health Affairs, refers to “the knowledge, skills and confidence a patient has for managing his or her health care.”

This sense of competency, researchers wrote, correlates with the quality of a patient experience. Not addressed is how this translates into patient action. But the study found activated patients were “adept at eliciting care experience that satisfied them,” and the difference showed among patients who fell into the activated and non-activated buckets who saw the very same provider. Ironically, this means the patients who think their job is to just comply with their HCP's advice will be less satisfied than those who feel they have a working relationship with their medical professional.

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