title: Do medical homes increase medication adherence for persons with multiple chronic conditions?
abstract: BACKGROUND
  Medications are an integral component of management for many chronic conditions, and suboptimal adherence limits medication effectiveness among persons with multiple chronic conditions (MCC). Medical homes may provide a mechanism for increasing adherence among persons with MCC, thereby enhancing management of chronic conditions.
  
  
  OBJECTIVE
  To examine the association between medical home enrollment and adherence to newly initiated medications among Medicaid enrollees with MCC.
  
  
  METHODS
  Retrospective cohort study comparing Community Care of North Carolina medical home enrollees to nonenrollees using merged North Carolina Medicaid claims data (fiscal years 2008-2010).
  
  
  METHODS
  Among North Carolina Medicaid-enrolled adults with MCC, we created separate longitudinal cohorts of new users of antidepressants (N=9303), antihypertensive agents (N=12,595), oral diabetic agents (N=6409), and statins (N=9263).
  
  
  METHODS
  Outcomes were the proportion of days covered (PDC) on treatment medication each month for 12 months and a dichotomous measure of adherence (PDC>0.80). Our primary analysis utilized person-level fixed effects models. Sensitivity analyses included propensity score and person-level random-effect models.
  
  
  RESULTS
  Compared with nonenrollees, medical home enrollees exhibited higher PDC by 4.7, 6.0, 4.8, and 5.1 percentage points for depression, hypertension, diabetes, and hyperlipidemia, respectively (P's<0.001). The dichotomous adherence measure showed similar increases, with absolute differences of 4.1, 4.5, 3.5, and 4.6 percentage points, respectively (P's<0.001).
  
  
  CONCLUSIONS
  Among Medicaid enrollees with MCC, adherence to new medications is greater for those enrolled in medical homes.
authors.affiliation: *RTI International Durham, NC †Department of Health Policy and Management, UNC Gillings School of Global Public Health ‡Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill §Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill ∥Community Care of North Carolina, Raleigh, NC.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Lichstein
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
authors.forename: C Annette
authors.initials: CA
authors.lastname: DuBard
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease / Q000188:drug therapy*; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D009657:North Carolina; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors