The Relationship Between the Adoption of Patient Centered Medical Home and the Quality of Medication Use: Results from the National Ambulatory Medical Care Survey.

Patient Centered Medical Home;Medication Quality of Care;Pharmacy and Pharmacology;Health Sciences;Social Sciences;Social and Administrative Sciences

Liu, Chi-MeiWest, Brady T ;

University of Michigan

关键词: Patient Centered Medical Home;    Medication Quality of Care;    Pharmacy and Pharmacology;    Health Sciences;    Social Sciences;    Social and Administrative Sciences;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/120816/liucm_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Background: Nearly 40% of adults age 65 and over report using five or more medications and one in five prescriptions in primary care are identified as inappropriate. Medication quality of care is a critical healthcare concern. To improve primary care, Patient-Centered Medical Homes (PCMHs) are considered a promising approach with a focus on systems-based quality and safety improvement. Evidence has demonstrated that PCMH adoption has many potential benefits. However, gaps exist in our knowledge regarding the potential benefits of PCMH in improving patient medication quality of care. Objectives: To quantify current ambulatory care practices’ level of PCMH adoption and determine practice-based and physician-related factors associated with the degree of PCMH implementation and to explore the association between the level of PCMH adoption in a practice and its impact on medication processes and outcome of care indicators. Methods: This study employed the 2009 and 2010 National Ambulatory Medical Care Survey (NAMCS) dataset, using a cross-sectional study design. For missing data, multiple imputations by chained equations were used to generate five complete data sets to provide improved statistical power. The use of high-risk medication (HRM), drug-disease interaction (DDIS), and the occurrence of adverse drug events (ADEs) were the three selected medication process and outcome quality indicators. The level of PCMH adoption was predicted, controlling for physician and practice characteristics.Results: Half of the ambulatory care settings in NAMCS adopted some aspect of PCMH during the observed study period. Physicians’ characteristics had significant associations with PCMH adoption, with older age and being female less likely to adopt PCMH. The prevalence of HRM, DDIS, and ADEs among the target populations were 11.2%, 15.0%, and 4.0%, respectfully. The adoption of PCMH was not associated with the selected medication quality indicators.Conclusion: PCMH was adopted by over 50% of practices throughout the Untied States and medication quality remains of concern. While the results did not support the impact of PCMH on medication use quality, these findings are limited to HRM, DDIS and ADE. Other quality measures, such as prevention and screening or disease-specific measures should be examined in the future studies.