The Effectiveness of a Comprehensive Wellness Assessment on Medication Adherence in a Medicare Advantage Plan Diabetic Population

Abstract

The issue of medication nonadherence has generated significant interest because of its complexity from both cost and outcomes perspectives. Of the 3.2 billion prescriptions written annually in the United States, estimates indicate that half are not taken as prescribed, especially among patients with asymptomatic chronic conditions. The objective of this study was to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs) in a Medicare Advantage (MA) plan diabetic population. The Centers for Medicare & Medicaid Services includes these medications among its triple-weighted measures.The researchers used a retrospective panel study employing administrative claims data and member month-level enrollment data for members who were newly diagnosed with diabetes since 2010, allowing for up to 5 years of follow-up. The treatment variable of interest was whether the enrollee had undergone a CWA in the 12 months prior to the study. Results for the full sample show that a CWA visit in the prior 12 months is significantly associated with increased adherence to statin medication (incidence rate ratio [IRR]: 1.022, t-test: 2.51) and oral diabetes medication (IRR: 1.032, t-test: 3.00), but it is not significantly associated with adherence to ACE/ARB medication (IRR: 1.009, t-test: 1.09). Results vary considerably in subsamples stratified by dual Medicare and Medicaid eligibility status, presence of certain chronic conditions, and age. CWAs are most beneficial when targeted toward dual-eligible members or members younger than 65. On the basis of these findings, improving medication adherence by targeting CWA visits to certain MA member subcategories may be more cost-effective than using CWAs for the full MA membership.

Strategies aiming to improve statin therapy adherence in older adults: a systematic review

“…Similarly, Faridi et al [ 25 ] showed that providing a first outpatient visit in the first week after discharge after a hospitalization for ST-elevation myocardial infarction or a non-ST-elevation myocardial infarction had a positive effect on patient adherence in patients when compared to first outpatient visits that took place more than 6 weeks after discharge. On the other hand, results by Guerard et al [ 26 ] and Kooy et al [ 27 ], using a comprehensive wellness assessment program or patient counselling combined with an electronic reminder device respectively, did not show any impact on statin adherence. Of note, although general results were inconclusive, Kooy et al [ 27 ] did report that using only the electronic reminder device had a positive effect on patient adherence in women in a secondary prevention setting (adjusted OR = 8.26 [2.20–31.0], p = 0.002).…”

“…Another study [ 27 ] reported a positive effect on adherence only in a sub-group of women who had the electronic reminder in a secondary prevention setting. The other two studies [ 26 , 33 ] reported no effect.…”

“…Similarly, our review also highlights that patients’ long-term adherence to statin is lacking. Indeed, though all 12 studies included at least some individuals followed up to at least 12 months (proportion of individuals followed up to 12 months differing in function of study design), only three [ 26 , 28 , 31 ] of these allowed the follow-up to extend beyond 12 months. When focusing specifically on these three studies, only one [ 28 ] showed a significant positive effect after 12 months (investigators assessing patients’ adherence at 18 months).…”

“…Table 1 shows the characteristics of the studies included in this review, with studies being grouped by intervention type, and by adherence measure. Out of 12 included studies, six had older adults as the population of interest [25][26][27][28][29][30], one study included only male patients who were 65 to 74 years old [31], and five included patients 65 years and older as sub-populations [32][33][34][35][36]. Only three studies [25,27,30] included patient retention rates for older adults.…”

“…Outcome measures varied between selected studies (Table 2). They were measured as PDC in nine studies [25][26][27][28][29][30][31][32]35], in terms of the MPR in one study [34], as discontinuation of statin treatment in two studies [32,33], and as a proportion of dispensation in one study [36]. More information on intervention characteristics is provided in Additional file 3.…”