Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What evidence exists for programs to increase patient adherence to prescription medications? Which programs/approaches are most effective at increasing adherence for which populations and conditions? If little or no evidence exists, can new research be designed to address the gap?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

--technological approaches include electronic pill holders and/or automated phone calls --strategies incorporated in disease management such as phone calls, visits to the provider’s office, and written records kept by the patient --delivery system strategies and financing strategic (incentives, reimbursement for care coordination to increase adherence of patients)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients with chronic diseases such as diabetes, heart disease and CAD.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Elderly men and women.

Patients with early or mid-stage dementia.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Increased adherence. Improved health outcomes defined by specific outcomes for the chronic condition.

Describe any health-related risks, side effects, or harms that you are concerned about.

Are there any adverse effects associated with adherence or increased adherence for any approach?

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

“Drugs don’t work in patients who don’t take them.” C. Everett Koop, M.D.

In patients with chronic illnesses, a recent New England Journal of Medicine article (Osterberg, L, Blaschke, T. Adherence to Medication. New England Journal of Medicine 2009; 353:5:487-497) described, up to 50% of patients “will discontinue their medications within six months of starting the therapy.” Furthermore, physicians’ ability “to recognize non-adherence is poor and intervention to improve adherence have had mixed results.” Understanding adherence is critical both to improving the results of clinical trials and to ensuring patients are getting the full benefit of medications for their health conditions. Failure to take prescribed medications impacts research and the ultimate availability of evidence, let alone individual health outcomes and costs to the health care system.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

While comparative effectiveness studies have done a strong job of comparing particular medications, few studies, if any, have looked at the medications from the perspective of adherence of patients in taking medications that are shown to be evidence-based. There are various disease management approaches and technological approaches that are currently being used to encourage (and measure) how patients are following their prescribed medications therapies. The comparative effectiveness of the care delivery and financial reimbursement and/or incentives to increase adherence will have an effect on both individual patient outcomes and overall healthcare system costs which is important to understand for all types of payers and decision makers.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

See above.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Evidence-based adherence strategies will be implemented. Evidence-based adherence strategies will be funded and resourced.

Describe the timeframe in which an answer to your question is needed.

When possible.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Evidence-based adherence strategies will be implemented. Evidence-based adherence strategies will be funded and resourced.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program