Many e-prescriptions were not filled. Previous studies of medication non-adherence failed to capture these prescriptions. Efforts to increase primary adherence could dramatically improve the effectiveness of medication therapy. Interventions that target specific medication classes may be most effective.

Objective The relationship between arthroplasty and long-term opioid use in patients with knee or hip osteoarthritis is not well studied. We examined the prevalence, patterns and predictors of persistent opioid use after hip or knee arthroplasty. Method Using claims data (2004–2013) from a U.S. commercial health plan, we identified adults who underwent hip or knee arthroplasty and filled ≥1 opioid prescription within 30 days after the surgery. We defined persistent opioid users as patients who filled ≥1 opioid prescription every month during the 1-year postoperative period based on group-based trajectory models. Multivariable logistic regression was used to determine preoperative predictors of persistent opioid use after surgery. Results We identified 57,545 patients who underwent hip or knee arthroplasty. The mean±SD age was 61.5±7.8 years and 87.1% had any opioid use preoperatively. Overall, 7.6% persistently used opioids after the surgery. Among patients who used opioids in 80% of the time for ≥4 months preoperatively (n=3,023), 72.1% became persistent users. In multivariable analysis, knee arthroplasty vs. hip, a longer hospitalization stay, discharge to a rehabilitation facility, preoperative opioid use (e.g., a longer duration and greater dosage and frequency), a higher comorbidity score, back pain, rheumatoid arthritis, fibromyalgia, migraine and smoking, and benzodiazepine use at baseline were strong predictors for persistent opioid use (C-statistic=0.917). Conclusion Over 7% of patients persistently used opioids in the year after hip or knee arthroplasty. Given the adverse health effects of persistent opioid use, strategies need to be developed to prevent persistent opioid use after this common surgery.

To date, there has been little empirical evidence to support the broader use of value-based insurance design, which lowers copayments for services with high value relative to their costs. To address this lack of data, we evaluated the impact of the value-based insurance program of a US corporation, Pitney Bowes. The program eliminated copayments for cholesterol-lowering statins and reduced them for clopidogrel, a blood clot inhibitor. We found that the policy was associated with an immediate 2.8 percent increase in adherence to statins relative to controls, which was maintained for the subsequent year. For clopidogrel, the policy was associated with an immediate stabilizing of the adherence rate and a four-percentage-point difference between intervention and control subjects a year later. Our study thus provides an empirical basis for the use of this approach to improve the quality of health care.

Background Multiple studies demonstrate poor adherence to medications prescribed for chronic illnesses, including osteoporosis, but few interventions have been proven to enhance adherence. We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve medication adherence for osteoporosis. Methods We conducted a one year randomized controlled clinical trial. Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries. All potentially eligible individuals had been newly prescribed a medication for osteoporosis. Consenting persons were randomized to either a program of telephone-based counseling (n = 1,046) using a motivational interviewing framework or a control group (n = 1,041) that received mailed educational materials. Medication adherence was the primary outcome compared across treatment arms and was measured as the median (interquartile range, IQR) medication possession ratio (MPR), calculated as the ratio of days with filled prescriptions to total days of follow-up. Results The groups were balanced at baseline, with a mean age of 78 years; 94% were female. In an intention-to-treat analysis, median adherence was 49% (IQR 7, 88) in the intervention arm and 41% (1.5, 86.0) in the control arm (P = 0.074 by Kruskal-Wallis test). There were no differences in self-reported fractures. Conclusions In this randomized controlled trial, we did not find a statistically significant improvement in osteoporosis medication adherence using a telephonic motivational interviewing intervention.