Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low-income patients and the role of patient-centered medical homes

Lisa P. Spees, Stephanie B. Wheeler, Xi Zhou, Krutika B. Amin, Christopher D. Baggett, Jennifer L. Lund, Benjamin Y. Urick, Joel F. Farley, Katherine E. Reeder-Hayes, Justin G. Trogdon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. Methods: Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-in-difference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-in-differences-in-differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. Results: Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. Conclusions: PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.

Original languageEnglish (US)
Pages (from-to)4770-4779
Number of pages10
JournalCancer
Volume126
Issue number21
DOIs
StatePublished - Nov 1 2020

Bibliographical note

Funding Information:
Supported by a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon). The database infrastructure used for this project was supported through the University of North Carolina (UNC) Clinical and Translational Science Award (UL1TR001111) and the UNC Lineberger Comprehensive Cancer Center, University Cancer Research Fund via the State of North Carolina.

Funding Information:
Lisa P. Spees was supported by the National Cancer Institute (T32‐CA‐116339). Stephanie B. Wheeler received a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon) for work performed as part of the current study and a grant from Pfizer for work performed outside of the current study. Xi Zhou received a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon) for work performed as part of the current study. Jennifer L. Lund has received a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon) for work performed as part of the current study. In addition, Dr. Lund's spouse is a full‐time employee of and owns stock in GlaxoSmithKline and Dr. Lund has received a grant from AbbVie for work performed outside of the current study. Benjamin Y. Urick has received a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon) for work performed as part of the current study and has received a grant to cover the cost of training a postdoctoral fellow in population health, real‐world evidence, and quality research from Janssen Pharmaceuticals for work performed outside of the current study. Joel F. Farley has received a grant from the National Institute on Aging (NIA R01 AG050733; principal investigator: Justin G. Trogdon) for work performed as part of the current study and has received personal fees from Takeda and a grant from AstraZeneca for work performed outside of the current study. Justin G. Trogdon has received a grant from the National Institute on Aging (NIA R01 AG050733), for which he is principal investigator, for work performed as part of the current study. The other authors made no disclosures.

Keywords

  • cancer
  • chronic conditions
  • health care use
  • medication adherence
  • patient-centered medical homes

PubMed: MeSH publication types

  • Journal Article

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