The PDC provides a more conservative estimate of adherence than the MPR across all types of users; however, the differences between the 2 methods are more substantial for persons switching therapy and prescribed therapeutic duplication, where MPR may overstate true adherence. The PDC should be considered when a measure of adherence to a class of medications is sought, particularly in clinical situations in which multiple medications within a class are often used concurrently.

Objective To estimate the effect of two separate policy changes in the North Carolina Medicaid program; the first reduced prescription lengths from 100 to 34 days' supply and the second increased copayments for brand name medications. Data Sources/Study Setting Medicaid claims data were obtained from the Centers for Medicare and Medicaid Services for January 1, 2000 – December 31, 2002. Study Design We used a pre-post controlled partial difference-in-difference-in-differences (DDD) design to examine the effect of the policy change on adults in North Carolina; adult Medicaid recipients from Georgia served as controls. Outcomes examined include medication adherence and Medicaid expenditures. Data Collection/Extraction Methods Data were aggregated to the person-quarter level. Individuals in HMOs, nursing homes, pregnant or deceased in the quarter were excluded. Principal Findings Both policies decreased medication adherence. The days' supply policy had a much larger effect on adherence than did the copayment increase. Total Medicaid spending declined from the days' supply policy but the copayment policy resulted in a net increase in Medicaid expenditures. Conclusions Although Medicaid costs decreased with the change in days supply policy, these savings were due to reduced adherence to these chronic medications. Additional research should examine the effect of these policy changes from the perspective of Medicaid enrollees.

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By knowing more about medical skepticism and other determinants of CAM provider use, conventional practitioners can target patients to improve their uptake of appropriate conventional care, while also monitoring patients alternative therapy use.

In this pilot study, we compared teams in rural North Carolina (NC) and urban Massachusetts (MA) to examine the how sites vary the implementation of the Assertive Community Treatment (ACT) model to respond to state and local circumstances. We analysed and compared data on: client characteristics using the NC-TOPPS and a modified survey in MA; Regional Demographics and; Team Characteristics. Issues such as driving distances, lack of qualified clinical staff, scarcity of physicians, and more limited oversight created impediments to fidelity in rural NC, despite higher per patient funding. ACT is now national, but variability in implementation of the model remains.