ACA could benefit prescription medication adherence

A new study finds a link between visits to primary care providers and the likelihood of following prescription regimens

Among its other impacts, the Affordable Care Act (ACA) may help improve patient adherence to prescription medication regimens.

That implication flows from a newly-published study examining factors associated with greater risk for nonadherence to prescription regimens. It finds that more patient visits with the prescribing physician is associated with increased adherence. “Although this has not been investigated previously, it has been assumed that the primary care health reforms taking place in many countries will enable better management of chronic conditions, including medication adherence,” the authors write.

The study, “The Incidence and Determinants of Primary Nonadherence with Prescribed Medication in Primary Care” appears in the April issue of the Annals of Internal Medicine. It was led by Robyn Tamblyn, PhD, professor in the departments of medicine and epidemiology and biostatistics at McGill University in Montreal, Quebec.

The study examines “primary nonadherence”-which the authors define as a patient not filling a prescription for a medication-among 16,000 patients in a primary care network in the Canadian province of Quebec between 2006 and 2009. It found that 31.3% of initial prescriptions went unfilled within nine months of the date they were written, and that higher copayments for medications, recent hospitalization, and more severe comorbid conditions also resulted in greater risk for primary nonadherence.

Among specific therapeutic indications, primary nonadherence was greatest for ischemic heart disease and headaches (51%), and depression (37%). The lowest incidence (26%) was for diseases of the genitourinary system. Nonadherence was nearly three times greater for drugs prescribed for a new indication compared with switching pharmacological class for the same indication.

Robyn Tamblyn, PhD, professor of medicine, McGill UniversityBy expanding Medicaid coverage and providing subsidies for healthcare insurance premiums, the ACA is expected to help more patients gain access to a primary care provider. According to the Obama administration, 7.1 million Americans had enrolled in a health plan through the end of March, although it is unclear how many of those were previously uninsured.

"There is no doubt, based on our own and many other studies, that providing individuals with better access to health care by better insurance coverage and more affordable pharmaceutical and health services that there will be an improvement in primary adherence to disease altering medication," Tamblyn wrote in an e-mail, adding that "[m]ost policies also have unintended effects, both good and bad, so timely evaluation is key so policies can be adjusted to avert the undesirable adverse effects."

The authors also note that “…more comprehensive healthcare strategies, such as medical homes and case managers, should improve continuity of care.” The ACA includes incentives to encourage experimentation with alternative care delivery methods, such as the Patient-centered Medical Home, that are intended to improve continuity of care.