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Association Between Adherence, Social Predictors Among Medicare Advantage Enrollees


April 16, 2021

Isolation, among other social determinants of health (SDoH) like economic instability, could play a role in reducing medication adherence, according to a poster presentation from AMCP 2021.

“It is postulated that addressing the nonmedical influences on an individual’s health can improve healthy behaviors and medical outcomes,” said the researchers. “A previous study reported an 11% reduction in total health care expenditure 1 year after meeting patients’ social needs.”

In order to quantify, researchers designed a study to examine the impact of SDoH on medication adherence among patients using angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), statins, and oral diabetes medications (ODMs).

The retrospective, cross-sectional study comprised 237 patients enrolled in a Texas Medicare Advantage Plan (MAP) between January 2019 and September 2020. Included patients were enrolled in a MAP from January 2019 to March 2021, completed a SDoH teleassessment between May and September 2020, and had a calculated proportion of days covered (PDC) rate for 2019, as determined through pharmacy claims. Patients with chronic kidney disease, cancer, in hospice or institutionalized care, or unable for the initial teleassessment were excluded.

Primary outcome was adherence measured per the Centers for Medicare & Medicaid Services with patients with PDC ≥ 0.80 considered adherent.

Fisher's Exact Test and Student's T test were used to evaluate differences between the adherent and nonadherent groups. Multivariable logistic regression was conducted to identify the predictors of adherence controlling for baseline characteristics, social predictors, and comorbidities.

“The adherent and nonadherent groups among those who took statins, ACEIs, ARBs, or ODMs were significantly different with respect to living alone (P=0.02) and number of daily medications (P=0.003),” found the researchers. “Significant predictors of adherence in the multivariate model included bathing help (OR 0.21; 95% CI 0.04-0.99; P=0.04) and feeling depressed within 2 weeks (OR 0.07; 95% CI 0.007-0.82; P=0.03).”

“Findings suggest that social isolation may negatively impact medication adherence,” explained the researchers. However, they noted: “The majority of patients in the sample were adherent which may have impacted the ability to detect significant differences with other predictors given the low sample size.”

“The use of evidence-based teleassessments, which identify unique health disparities, can aid managed care organizations in identifying patients in need of intervention,” concluded the researchers. “Our future work will evaluate the potential improvement in adherence in 2021 after the implementation of the initiative.”

—Edan Stanley

Reference:
Laxa SL, Esse T, Mohan A, Serna O, Abughosh A. Evaluating social predictors of medication adherence and health outcomes in patients within a Medicare Advantage Plan (MAP). Poster presented at: AMCP 2021, April 12-16, 2021; Virtual. 

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