Impact of primary care intensive management on medication adherence and adjustments.

Abstract

The Veterans Health Administration implemented a pilot program for primary care intensive management (PIM) for patients at high risk for hospitalization. We examined the impact of the program on medication adherence and adjustments for patients with chronic conditions. A randomized quality improvement trial was conducted in 5 sites in which high-risk patients were randomized into PIM or usual primary care; outcomes were measured in the 12 months before and after randomization. Interdisciplinary PIM teams assessed patients for unmet needs and offered services including pharmaceutical care and care coordination. Outcomes included adherence, measured by proportion of days covered, and several measures of medication adjustments for diabetes, depression, hyperlipidemia, and hypertension medications. Differences-in-differences methods were used to estimate changes in outcomes between PIM and usual care groups. There were 1527 patients in the medication adherence cohort and 1719 in the medication adjustments cohort. Mean adherence was mostly similar between groups but 16% higher among PIM patients for dipeptidyl-peptidase-4 (DPP-4) inhibitors (for diabetes) after randomization (0.12 vs -0.04; P = .02). The mean number of hyperlipidemia drugs filled was higher among PIM patients (1.1 vs 1.0; P = .006). The mean number of discontinued depression medications was higher and the mean number of dose changes for hypertension medications was lower for PIM patients, although these comparisons did not reach statistical significance. Medication adherence improved for DPP-4 inhibitors, and more hyperlipidemia drugs were prescribed for PIM patients. Overall impacts of PIM were modest.