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BACKGROUND/RATIONALE:
While medication therapy for control of chronic conditions such as hypertension, diabetes and hyperlipidemia has improved dramatically over the past 20 years, control of these diseases and overall risk reduction for patients with chronic conditions remain uniformly poor. Many patient level characteristics, such as age, gender, degree of comorbidity, and financial hardship are predictive of adherence to medications, but they are extremely difficult to modify. The delivery of health care, on the other hand, is in the control of the health care organization. To date there has been limited research on characteristics of health care facilities that support adherence to medications through better education, easier access, more subspecialty resources, or special quality improvement programs for specific diseases.
OBJECTIVE(S):
Our objectives in this study are to 1) identify variation in medication adherence at the facility level, and 2) identify factors or combinations of factors that are associated with adherence and can also be modified by clinical or policy decisions to improve medication adherence and patient outcomes.
METHODS:
This is a longitudinal cohort study using data routinely collected by VA for administrative purposes, and additional data collected through surveys and interviews with primary care clinicians in VA facilities. We will identify a cohort of all diabetes patients among VA primary care users in FY2006 to document variation in medication adherence across facilities in FY2007. We will identify patients with diabetes who responded to the Outpatient Survey of Health Experiences of Patients (SHEP) in FY2006, using adherence data from FY2007 to examine organizational factors associated with medication adherence. Secondary data used for this study include patient-level diagnostic, clinical, and pharmacy data from VA national administrative databases, demographic information and health status from patient responses to the VA's Survey of Health Experiences of Patients, and organizational data from the VA's Clinical Practice Organizational Survey. We will collect additional data on decision support and patient self-management support via surveys of primary care clinicians, with follow-up telephone interviews to elicit qualitative data on interventions to improve adherence. We will use bivariate and multivariate statistical analyses to identify variation in adherence and factors associated with improved adherence; descriptive analyses of survey results for comparison with multivariate analyses, and content analysis of interview data.
FINDINGS/RESULTS:
No findngs at this time.
IMPACT:
This study will use a cohort of primary care patients with diabetes to examine facility level variation in adherence to medications for three target conditions - diabetes, hypertension, and hyperlipidemia - common to this cohort. This study will provide a better understanding of modifiable, system-level factors that are associated with improved patient adherence to medications and improved risk for patients with chronic conditions that affect a large proportion of VA patients. The study results are intended to lead directly to recommendations for system-level changes that can reduce health care costs and improve clinical outcomes for patients with diabetes, hypertension and hyperlipidemia.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Behavior (provider), Adherence
MeSH Terms:
none
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