Clinical Metric and Medication Persistency Effects: Evidence from a Medicaid Care Management Program

Abstract

The objective was to estimate clinical metric and medication persistency impacts of a care management program. The data sources were Medicaid administrative claims for a sample population of 32,334 noninstitutionalized Medicaid-only aged, blind, or disabled patients with diagnosed conditions of asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, or heart failure between 2005 and 2009. Multivariate regression analysis was used to test the hypothesis that exposure to a care management intervention increased the likelihood of having the appropriate medication or procedures performed, as well as increased medication persistency. Statistically significant clinical metric improvements occurred in each of the 5 conditions studied. Increased medication persistency was found for beta-blocker medication for members with coronary artery disease, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and diuretic medications for members with heart failure, bronchodilator and corticosteroid medications for members with chronic obstructive pulmonary disease, and aspirin/antiplatelet medications for members with diabetes. This study demonstrates that a care management program increases the likelihood of having an appropriate medication dispensed and/or an appropriate clinical test performed, as well as increased likelihood of medication persistency, in people with chronic conditions.

Methods to assess COPD medications adherence in healthcare databases: a systematic review

“…Finally, the impact of early refills was assessed in 46 out of 116 studies (exclusion of initiation studies and implementation methods based on all days supplied as oversupply is automatically included). In general, for patients who refilled Time between end of one prescription and the start of a subsequent one Treatment gap of >X days between the end of one prescription and the start of the subsequent one [16,30,37,41,43,51,58,59,62,63,79,81,109,112,126,128,147,149,151,158,173,176] Treatment gap of >X days between the end of one prescription (prescription end corrected for early refills) and the start of the subsequent one [47,60,80] Treatment gap of >X days between the end of one prescription (prescription end corrected for inpatient stays) and the start of the subsequent one [38,91] Treatment gap of >X days between the end of one prescription (prescription end corrected for early refills and inpatient stays) and the start of the subsequent one [98,119] Treatment gap of >X days (value of X adapted for inpatient stays) between the end of one prescription and the start of the subsequent one [85] Treatment gap of >X days between the end of one prescription and the start of the subsequent one and no re-initiation during the subsequent period [154,155]…”