Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low‐income patients and the role of patient‐centered medical homes

Abstract

BACKGROUND: Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. METHODS: Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-indifference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-indifferences in differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. RESULTS: Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. CONCLUSIONS: PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.

Diabetes mellitus in long‐term survivors with colorectal, breast, or prostate cancer: Prevalence and prognosis. A population‐based study

“…This calls for better communication and coordination between specialists and general practitioners to ensure continuity of care of cancer survivors with DM. Cancer and its treatments may distract individuals with preexisting DM from routine DM management (e.g., poorer adherence to DM medication) 38–40 . As such, keeping a continuous satisfactory DM and hyperglycemia management is essential during long‐term cancer survivorship, and diabetic cancer survivors could benefit from good medication adherence for DM 41 …”

“…Cancer and its treatments may distract individuals with preexisting DM from routine DM management (e.g., poorer adherence to DM medication). [38][39][40] As such, keeping a continuous satisfactory DM and hyperglycemia management is essential during long-term cancer survivorship, and diabetic cancer survivors could benefit from good medication adherence for DM. 41 Contrary to previous studies that reported that the prevalence of DM and the risk of new-onset DM in cancer survivors increased with cancer stage and cancer treatment, 3,13,42 our study revealed that cancer stage and cancer treatment were not significantly associated with DM prevalence and incidence in LTCS.…”

To What Extent Are ACO and PCMH Models Advancing the Triple Aim Objective? Implications and Considerations for Primary Care Medical Practices

“…The PCMH model has the potential to reduce racial disparities, but additional unique protocols that address minority populations' needs are necessary. Spees et al (2020) found that PCMHs were associated with improved expenditures and fewer emergency department visits among some low-income cancer patients. However Reddy et al (2015) studied 56 Veterans Health Administration primary care sites using the 5 domains of patient care experience from the Survey of Healthcare Experiences of Patients and did not find an improvement in patient experience among sites that were PCMHs.…”