4L-2
PATIENTS' INVOLVEMENT IN TREATMENT DECISION-MAKING IS ASSOCIATED WITH IMPROVED ADHERENCE TO CHRONIC DISEASE MEDICATIONS IN AN AMBULATORY CARE SETTING
Method: We retrospectively identified adult managed-care beneficiaries in the electronic health records (EHR) of a healthcare system between 2010 and 2014. We required patients to have: (i) completed a Press-Ganey Patient Experience Survey; (ii) a prescription for a chronic disease medication ±14 days of the office encounter associated with the survey; (iii) corresponding pharmacy fills for the medications of interest; and (iv) ≥12 months of EHR activity prior to the date of the prescription. Patients’ rating of a “provider’s efforts to include you in decisions about your treatment” is answered on a scale from 1 (very poor) to 5 (very good), and was dichotomized as “very good” vs. not “very good”. We measured adherence as the proportion of days covered (PDC), calculated as the total days’ supply of fills divided by the length of the prescription (start to end date). A PDC ≥80% was considered adherent. We used logistic regression to test the association between adherence (outcome) and rating of treatment decision-making (main predictor), with and without controlling for other important variables, including sex, age, race/ethnicity, comorbidities, and average copayment. Odds ratios (ORs) and 95% confidence intervals (CIs) were generated.
Result: We identified 14,800 patients meeting study eligibility criteria. The most commonly prescribed medications in this cohort included antihypertensive (38.7%), antihyperlipidemic (17.0%), psychiatric (10.8%), antidepressant (10.2%), thyroid (7.2%), and antidiabetic (6.2%) agents. The overall adherence rate was 56%. Univariate analyses showed that a higher rating of treatment decision-making was significantly associated with greater odds of adherence (OR: 1.09; 95% CI: 1.00-1.18; P=0.042). This relationship persisted after controlling for other covariates (adjusted OR: 1.10; 95% CI: 1.01-1.20; P=0.025). The strongest association between rating of treatment decision-making and adherence was for antidiabetic agents (adjusted OR: 1.48; 95% CI: 1.05-2.09; P=0.025).
Conclusion: In this retrospective study of managed-care beneficiaries within a large healthcare delivery system, patients’ rating of their involvement in treatment decision-making was positively associated with statistically significant improvements in adherence to chronic disease medications. Therapeutic class effects were observed. Health systems and healthcare providers should be encouraged to involve patients in shared decision-making whenever appropriate to maximize adherence.