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
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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
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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
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/ww sue incentives between payers and providers, and 6) provider
:/tsp lan training and coordination of care.16 Since this publication,
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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. Th (...truncated)