Research Area: Increasing Medication Adherence, Safety, and Prescribing

Medication adherence is a complex healthcare challenge that can not only impact patient outcomes and management of chronic and acute conditions, but is also one of the largest contributors to avoidable healthcare costs. For example, the American Heart Association reports poor medication adherence contributes to 125,000 annual patient deaths and can cost healthcare organizations up to $300 billion annually in increased healthcare utilization costs. AMGA works to not only understand barriers and facilitators to patient adherence, but also to identify and implement systematic solutions to increase medication adherence, improve patient outcomes, and reduce healthcare costs.

Anticoagulants 

• Medication Adherence to Direct Oral Anticoagulants (DOACs) in patients with Non-valvular atrial fibrillation (NVAF): AMGA is actively working with three members on patient-, provider-, and health system-level interventions to improve medication adherence to direct oral anticoagulants for patients with non-valvular AFib. Findings coming in 2025.

• Primary Adherence Oral Anticoagulants: AMGA is finalizing an analysis of primary adherence to oral anticoagulants. Preliminary findings indicate more than 20% of patients do not fill their first prescription and lower adherence was noted among older patients without Medicare Part D coverage; males; patients with moderate comorbid burden; and patients with a primary care or advanced practice provider (APP) prescriber. Additionally, patients who do not fill medications immediately were much less likely to become adherent (at the time of script 76% chance to become adherent vs. 45% chance after 1 day). Complete findings coming soon!

• Interventions to Improve Transitions of Care for VTE: Creating safe care transitions for patients with VTE throughout their ED, hospital, and outpatient experience. Six AMGA members used implementation science-informed approaches to identify gaps, develop, and implement methods for improved management of patients with VTE during critical times of transition between emergency departments, inpatient, and outpatient settings. Learn More

• Provider Perspectives on Transitions of Care VTE: Roundtable discussions were held with experts from 12 AMGA member organizations to understand how groups manage patient discharge after hospital treatment for VTE, ensuring continuity of treatment in the outpatient setting. Learn More

Anti-glycemic

• Impact of Continuous Glucose Monitors (CGMs) on Glycemic Control: In a prospective, embedded pragmatic clinical trial with retrospectively matched control patients, researchers examined the association of real-time continuous glucose monitors (CGMs) use with glycemic control among individuals with type 2 diabetes receiving primary care. All patients had a decrease in HbA1c, with 86% of patients with CGMs experiencing decrease compared to 72% in control group (p<0.01). Patients not yet on intensive insulin who used CGMs for 3-months had significant reduction in HbA1C compared with matched control patients (p<0.01). Learn More

• Enabling Patients to Monitor Their Blood Glucose: Enabling T2DM patients to monitor their blood glucose using continuous glucose monitors (CGMs). Study found that CGM use in primary care cajournals.sagepub.com/doi/10.1177/19322968231171176n significantly improve glycemic control in T2DM patients upstream of insulin initiation. Learn More
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• Provider Perspectives Basal Insulin Initiation: To contextualize findings from a database study about patients with T2DM, primary care providers were interviewed to identify perceived barriers and facilitators to basal insulin initiation. Providers expressed their and patients’ desire to obtain data driven feedback from continuous glucose monitors, but with a need to better understand insurance benefits and access. Learn More

• Therapeutic Inertia in Type 2 Diabetes Mellitus (T2DM) Management: Retrospective database study with 22 AMGA members found 50% of T2DM patients after 6 months and 10% after 24 months lacked treatment intensification to control blood glucose levels. Learn More

Opioids

• CME: Strategies for Effective Pain Management: AMGA has been awarded for the fourth year in a row an FDA grant to support Continuing Medical Education (CME) for members to receive honoraria for participation in the course Practical Approaches to Comprehensive Treatment of Pain (certified for 3.5 AMA PRA Category 1 Credit and AANP contact hour, ABIM Medical Knowledge MOC credit). To date, 1174 providers have completed the CME course across17 AMGA groups. Providers can meet the DEA’s MATE requirements with these modules plus the additional activities available at no cost. Members who previously participated may sign up again.  For more information contact: research@amga.org

• Identifying Chronic Opioid Use (COU) in Patients with Osteoarthritis (OA): Over 5% of osteoarthritis patients experience a new period of chronic opioid use (COU) within a given year, however these patients can be identified using EHR data allowing more timely intervention. Learn More
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Anti-hypertensives

• Barriers to Blood Pressure Control Across Specialties: To contextualize findings from a database study on resistant hypertension, cardiologists and primary care physicians were interviewed about their approaches to treatment. Even among providers of the same specialty, diverse perspectives and approaches arose. Learn More 

• Initiation, Engagement, and Retention of Medications for Opioid Use Disorder (MOUD): Among patients with incident opioid use disorder, a high medical deductible ($1000+) was associated with lower odds of initiation of medication for opioid use disorder (MOUD) compared with no deductible. Initial 30-day out-of-pocket costs ranged from $100 (methadone) to $710 (extended-release naltrexone). Learn More

• Potential Barriers for Individuals Desiring MOUD: Among patients with a new diagnosis of OUD who had a prescription written for buprenorphine or oral naltrexone- 70% filled the prescription within 30 days with 57% filling on the day it was written. Fill rates were greater for patients with copays at or below the mean. Learn More

Prostate cancer

• Primary Adherence to Oral Anti-Prostate Cancer Medications: AMGA is finalizing a database study to better understand trends in primary adherence to oral anti-prostate cancer medications. Preliminary findings indicate differences in adherence by drug type, insurance type, and prescriber. Interviews with practicing urologic oncologists were completed to contextualize findings highlighted challenges with navigating specialty pharmacies, lack of consistent adherence documentation, and patient follow-up after initial prescribing. Complete findings coming soon!