Adherence and health care costs

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Abstract

Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e)-prescribing.

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Most cited references 89

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Eliminating waste in US health care.

Donald M Berwick, Andrew D. Hackbarth (2012)

The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.

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The medical home: growing evidence to support a new approach to primary care.

Thomas Rosenthal (2024)

A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient's health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans.

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Initial validation of a self-report measure of the extent of and reasons for medication nonadherence.

William S Yancy, Patrick Gallagher, Bryce B Reeve … (2012)

Self-report measures of medication nonadherence confound the extent of and reasons for medication nonadherence. Each construct is assessed with a different type of psychometric model, which dictates how to establish reliability and validity. To evaluate the psychometric properties of a self-report measure of medication nonadherence that assesses separately the extent of nonadherence and reasons for nonadherence. Cross-sectional survey involving the new measure and comparison measures to establish convergent, discriminant, and predictive validity. The new measure was readministered 2-21 days later. A total of 202 veterans with treated hypertension were recruited from the Durham Veterans Affairs Medical Center. A new self-report measure assessed the extent of nonadherence and reasons for nonadherence. Comparison measures included self-reported medication self-efficacy, beliefs about medications, impression management, conscientiousness, habit strength, and an existing nonadherence measure. Three items assessing the extent of nonadherence produced reliable scores for this sample, α = 0.84 (95% confidence interval, 0.80-0.87). Correlations with comparison measures provided evidence of convergent and discriminant validity. Correlations with systolic ( r = 0.27, P < 0.0001) and diastolic (r = 0.27, P < 0.0001) blood pressure provided evidence of predictive validity. Reasons for nonadherence were assessed with 21 independent items. Intraclass correlations were 0.58 for the extent score and ranged from 0.07 to 0.64 for the reasons. The dual conceptualization of medication nonadherence allowed a stronger evaluation of the reliability and validity than was previously possible with measures that confounded these 2 constructs. Measurement of self-reported nonadherence consistent with psychometric principles will enable reliable, valid evaluation of interventions to reduce nonadherence.

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Author and article information

Journal

Journal ID (nlm-ta): Risk Manag Healthc Policy

Journal ID (iso-abbrev): Risk Manag Healthc Policy

Title: Risk Management and Healthcare Policy

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1594

Publication date Collection: 2014

Publication date (Electronic): 20 February 2014

Volume: 7

Pages: 35-44

Affiliations

[1 ]Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

[2 ]Johns Hopkins University, Baltimore, MD, USA

[3 ]Johns Hopkins Community Physicians, Baltimore, MD, USA

[4 ]Johns Hopkins University School of Medicine, Baltimore, MD, USA

Author notes

Correspondence: Maura J McGuire, Johns Hopkins Community Physicians, Johns Hopkins University School of Medicine, 3100 Wyman Park Drive, Baltimore, MD 21211, USA, Email mmcguir1@ 123456jhmi.edu

Article

Publisher ID: rmhp-7-035

DOI: 10.2147/RMHP.S19801

PMC ID: 3934668

PubMed ID: 24591853

SO-VID: 7401b4f7-78b3-46a9-9593-3ef97e3b6101

License:

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Adherence and health care costs

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Most cited references 89

Eliminating waste in US health care.

The medical home: growing evidence to support a new approach to primary care.

Initial validation of a self-report measure of the extent of and reasons for medication nonadherence.

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