The concept of a patient-centered medical home (PCMH) holds intuitive appeal, with its emphasis on coordination of care, improved patient-provider communication and patient engagement, use of health information technology, and expanded practice hours.
Trends in P2Y12 Receptor Inhibitor Use and Adherence After Percutaneous Coronary Intervention, 2008-2016
Post-angioplasty, patient adherence to recommended antiplatelet therapy decreased when newer, more expensive drugs were introduced. From 2008-2016, as the use of newer agents increased, the proportion of patients not filling any antiplatelet prescription within 30 days of discharge increased from 6.4% to 19.1%. In the subsequent 12 months, the newer drugs were associated with higher patient costs and lower adherence to recommended therapy.
Abstract [from journal]
Background: Poor medication adherence is common and limits the effectiveness of treatment.
Objective: To investigate how social supports, automated alerts, and their combination improve medication adherence.
Design: Four-arm, randomized clinical trial with a 6-month intervention.
Participants: A total of 179 CVS health employees or adult dependents with CVS Caremark prescription coverage, a current daily statin prescription, a medication possession ratio less than 80%,...
Association of high cost sharing and targeted therapy initiation among elderly Medicare patients with metastatic renal cell carcinoma
In Cancer Medicine, Pengxiang (Alex) Li and colleagues, including Jalpa Doshi, explore whether high out-of-pocket costs limit access to oral therapies for Medicare patients newly diagnosed with metastatic renal cell carcinoma. Using 2011–2013 Medicare claims, the investigators identified 1,721 patients newly diagnosed with metastases in the liver, lung, or bone. They compared low-income Medicare Part D beneficiaries (who had low out-of-pocket costs due to...
The Food and Drug Administration (FDA) recently approved the first digital pill that tracks if patients have taken their medication. Our experts weighed in on the potential benefits of the new technology, as well as the potential for abuse.
Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People With Mental Illness
In AIDS and Behavior, Marlene Eisenberg and colleagues, including Nancy Hanrahan and Michael Blank, examine if a high-intensity HIV-treatment intervention would be perceived as coercive by HIV-positive individuals with serious mental illness. Previous research has shown that potentially coercive mandates during the earliest stages of mental health treatment are associated with later treatment benefits. Furthermore, the prevalence of HIV is significantly higher among populations with mental illness. The authors developed an HIV management regimen that utilized advance practice...
Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction
In JAMA Internal Medicine, Kevin Volpp and colleagues, including Shivan Mehta, Christian Terwiesch, Kristen Caldarella, and David Asch, investigate whether medication reminders, as well as financial and social support, delay re-hospitalization for a vascular event. The authors randomized participants to either a usual care group (the control), or to an intervention using electronic pill bottles, lottery incentives, and social support for medication adherence. The primary measured outcome of this study was time to first vascular-related re-hospitalization or death, but the authors...
Financial Incentives for Adherence to Hepatitis C Virus Clinical Care and Treatment: A Randomized Trial of Two Strategies
In Open Forum Infectious Diseases, David Wohl and colleagues, including Harsha Thirumurthy, assess the feasibility of two strategies for financially incentivizing adherence to Hepatitis C (HCV) care among patients with substance use disorders. Previous research has shown that, although rates of a sustained response to the virus (SVR) surpass 90%, patients experiencing substance use disorders may struggle to adhere to HCV care. The authors randomly assigned participants to either a fixed or lottery-based monetary incentive for attending clinic appointments, adhering to medications...