New quality measures gauge medication adherence

Metrics aim to help improve drug management, but could physicians be penalized when patients fail to take their meds?

By Kevin B. O’Reilly — Posted Sept. 18, 2009

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Making sure patients take the right drugs at the right time is a challenge.

About 40% of patients don't take their drugs as prescribed, and about 1.5 million patients are harmed annually by drug errors in prescribing and dispensing, according to a July 2006 Institute of Medicine report. Nearly a quarter of elderly patients receive inappropriate prescriptions, the National Quality Forum says.

Despite these alarming figures, health plans, physician practices and hospitals often have little clue how they fare on medication adherence and safety. A new set of 18 metrics endorsed by the NQF in August is designed to help gauge performance so it can be improved (link).

The NQF-endorsed standards target conditions -- diabetes, asthma, coronary artery disease, chronic obstructive pulmonary disease and others -- in which nonadherence is common.

"We believe that these are a good start on improving on and measuring medication safety," said Paul Conlon, PharmD, who co-chaired the NQF panel that endorsed the measures. He is senior vice president of clinical quality and patient safety at Trinity Health, the Novi, Mich.-based Catholic health system of 45 hospitals and 379 clinics in seven states.

Some of the measures look at how well hospitals reconcile patients' medications upon discharge, but most focus on ambulatory settings. For example, a measure developed by the Centers for Medicare & Medicaid Services would draw upon claims data to see what percentage of adult patients with diabetes get statins, ACE inhibitors and oral hypoglycemic medications.

But could doctors be graded unfairly by rating systems or lose out on financial incentives due to patient noncompliance? It is a tricky question, Conlon said.

"There's still a lot to understand about the level of influence a physician may have in helping patients adhere to their medication regimens," he said. "You have to be careful in assigning attribution solely to the physician. There can be patient population differences and socioeconomic differences that the physician may not have control over."

Better data on medication adherence and management will provide only half the story, Conlon said. The rest will come when doctors and hospitals are compared to see who performs the best and why.

"There's not going to be a single intervention that's going to make a dramatic change," Conlon said. "And I think there's no substitute for a good physician-patient relationship in this."

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