Primary Care Intensive Management Teams Impact Medication Management for Diabetes and Hyperlipidemia
In 2014, VA began pilot testing primary care intensive management (PIM) to improve the management of patients at high risk for hospitalization. While PIM programs were primarily intended to improve the management of these patients and reduce the unnecessary use of acute care, they also may have impacted medication adherence and adjustments. This study examined the impact of PIM on adherence to medications and medication adjustments including changes in number of drugs filled, switches between drug classes, added or discontinued prescriptions, and dose changes. Investigators compared these outcomes for diabetes, depression, hypertension, and hyperlipidemia drugs among patients randomly assigned to PIM or usual primary care (usual care was provided through a patient-aligned care team or PACT) after 12 months of program enrollment (through FY2016). Conducted at five VA sites, this study included 1,527 Veterans with medication adherence measures and 1,719 Veterans with medication adjustment measures; Veterans had at least one diagnosis for diabetes, depression, hypertension, or hyperlipidemia â€“ and VA prescription records for medications to treat these conditions.
- Although impacts were modest, PIM teams appear to have contributed to medication management for diabetes and hyperlipidemia. Medication adherence improved for DPP-4 inhibitors (class of drugs used to control high blood sugar in adults with type 2 diabetes), and more hyperlipidemia drugs were prescribed for PIM patients.
- In adjusted analysis, there was a 12% increase (79% to 91%) in predicted mean adherence to DPP-4 inhibitors for diabetes in PIM patients between pre- and post-randomization, while usual care PACT patients had a 4% decrease (71% to 67%) in predicted mean adherence.
- PIM patients had a significantly higher mean number of hyperlipidemia drugs at study end due to more hyperlipidemia prescriptions added in the post-randomization period. Other outcomes were not statistically significant.
- The potential of PIM programs to continue to develop and spread may depend on better targeting of patients appropriate for intensive management interventions – and a better understanding of the mechanisms needed to improve patients’ adherence and self-management of chronic conditions.
- The study time period may have been too short to observe improvements in outcomes since it took several months for PIM teams to contact patients after receiving list of assigned patients
- Investigators were unable to include prescriptions not filled through a VA pharmacy.
This study was partly funded by HSR&D’s Quality Enhancement Research Initiative (QUERI). Drs. Yoon and Wu are part of HSR&D’s Health Economics Resource Center (HERC) in Palo Alto, CA, and Dr. Chang is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) in Los Angeles, CA.
Yoon J, Wu F, and Chang E. Impact of Primary Care Intensive Management on Medication Adherence and Adjustments. American Journal of Managed Care. August 7, 2020;26(8):e239-245.