The new landscape of medication adherence improvement: where population health science meets precision medicine

Patient Preference and Adherence, Jul 2018

The new landscape of medication adherence improvement: where population health science meets precision medicine Leah L Zullig,1,2 Dan V Blalock,1,3 Samantha Dougherty,4 Rochelle Henderson,5 Carolyn C Ha,4 Megan M Oakes,2 Hayden B Bosworth1–3,6 1Durham Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; 4Pharmaceutical Research and Manufacturers of America, Washington, DC, USA; 5Express Scripts Holding Company, St Louis, MO, USA; 6School of Nursing, Duke University, Durham, NC, USA Abstract: Despite the known health and economic benefits of medications, nonadherence remains a significant, yet entirely preventable public health burden. Over decades, there have been numerous research studies evaluating health interventions and policy efforts aimed at improving adherence, yet no universal or consistently high impact solutions have been identified. At present, new challenges and opportunities in policy and the movement toward value-based care should foster an environment that appreciates adherence as a mechanism to improve health outcomes and control costs (eg, fewer hospitalizations, reduced health care utilization). Our objective was to provide a commentary on recent changes in the landscape of research and health policy directed toward improving adherence and an actionable agenda to achieve system level savings and improved health by harnessing the benefits of medications. Specifically, we address the complementary perspectives of precision medicine and population health management; integrating data sources to develop innovative measurement of adherence and target adherence interventions; and behavioral economics to determine appropriate incentives. Keywords: adherence, policy, precision medicine, population health

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The new landscape of medication adherence improvement: where population health science meets precision medicine

Patient Preference and Adherence The new landscape of medication adherence improvement: where population health science meets precision medicine Leah L Zullig 1 2 3 Samantha Dougherty 3 6 Rochelle Henderson 3 5 Carolyn C Ha 3 6 Megan M Oakes 1 3 Hayden B Bosworth 2 3 0 Department of Psychiatry and Behavioral Sciences, Duke University , Durham, NC , USA 1 Department of Population Health Sciences, Duke University , Durham, NC , USA 2 Durham Center for Health Services Research in Primary Care, Durham v eterans Affairs Health Care System , Durham, NC , USA 3 Dan v Blalock 4 School of Nursing, Duke University , Durham, NC , USA 5 express Scripts Holding Company , St Louis, MO , USA 6 Pharmaceutical Research and Manufacturers of America , w ashington, DC , USA Despite the known health and economic benefits of medications, nonadherence remains a significant, yet entirely preventable public health burden. Over decades, there have been numerous research studies evaluating health interventions and policy efforts aimed at improving adherence, yet no universal or consistently high impact solutions have been identified. At present, new challenges and opportunities in policy and the movement toward value-based care should foster an environment that appreciates adherence as a mechanism to improve health outcomes and control costs (eg, fewer hospitalizations, reduced health care utilization). Our objective was to provide a commentary on recent changes in the landscape of research and health policy directed toward improving adherence and an actionable agenda to achieve system level savings and improved health by harnessing the benefits of medications. Specifically, we address the complementary perspectives of precision medicine and population health management; integrating data sources to develop innovative measurement of adherence and target adherence interventions; and behavioral economics to determine appropriate incentives. adherence; policy; precision medicine; population health - open access to scientific and medical research having a relatively modest improvement in adherence for an individual patient, when interventions are scaled up to a population level there may be potential for significant improvement in public health (eg, a small increase in prescription refill rates could be associated with significant decreases in health care use).14 Yet even for promising strategies, only a small portion of research findings are translated to benefit patient care, and the time lag for implementation can be considerable.15 8 1 0 2 l u J 3 1 7on Research and health policy agenda .260 to improve medication adherence .495 In 2014, a research agenda to improve adherence was pro.37 posed by Seabury et al.16 In their commentary, Seabury et al /yb defined six key areas to forward the medication adherence .com research agenda: 1) prediction of nonadherence, 2) behavrsse ioral factors affecting nonadherence, 3) measurement of p .vdow l.yno t4h)eeifmfepcatcivt eonfenssonoafdhexerisetnicneg oinntehrevaeltnhtiaonnds, c5o)stmoiustacloigmneesd, e /ww sue incentives between payers and providers, and 6) provider :/tsp lan training and coordination of care.16 Since this publication, ftroedhm rrspeooF ttihoenreadhhaserbeenecne,inbcurtelaitstilnegaadwvaanrecneemsesnitnitnhoeutorpuincdoefrsmtaenddiicnagof how to realize the benefits of adherence. Additionally, there are new challenges and opportunities in the context of the evolving US health care system that impact adherence enhancing initiatives. As an example of the latter new challenges, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the movement toward value-based care should foster an environment that appreciates adherence as a mechanism to improve health outcomes. Last year, the Pharmaceutical Research and Manufacturers of America (PhRMA) Foundation convened health policy and research experts representing patients, physicians, pharmacies, and the biopharmaceutical and insurance industries to gain consensus around priorities to address the adherence problem.17 Now, we take the next step to suggest several novel, targeted, and actionable research and policy agenda items to advance the field of medication adherence: 1) using a standardized taxonomy to describe adherence, adherencerelated study results, and quality reporting; 2) appreciating the complementary perspectives of precision medicine and population health management; 3) integrating data sources to develop innovative measurement of adherence and target recipients of adherence interventions (eg, targeting patients at high risk for hospitalization or rehospitalization); and 4) considering behavioral economics and determining the appropriate population and payer level incentives. 1226 Standardized taxonomy To support a stronger role of adherence in the broader goals of moving to a value-based health care system, there has been movement in the scientific literature to classify medication adherence into phases. 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Leah L Zullig, Dan V Blalock, Samantha Dougherty, Rochelle Henderson, Carolyn C Ha, Megan M Oakes, Hayden B Bosworth. The new landscape of medication adherence improvement: where population health science meets precision medicine, Patient Preference and Adherence, 2018, pp. 1225-1230, DOI: 10.2147/PPA.S165404