Rationale Pulmonary arterial hypertension (PAH) is a rare form of pulmonary hypertension (PH). The 2022 ESC (European Society of Cardiology)/ERS (European Respiratory Society) guidelines recommend special treatment considerations for patients with cardiopulmonary comorbidities (CPCs): hypertension, obesity, coronary heart disease, and diabetes. The understanding of CPCs in PAH in the United States (US) is limited. This analysis assessed the impact of CPCs on healthcare resource utilization (HCRU) among patients diagnosed with PAH in the US. Methods This retrospective cohort study utilized electronic medical records data from TriNetX, with linkage to claims data from PurpleLabs for a subset of patients. Newly-diagnosed adult (18+) PAH patients were identified through having a new prescription of a PAH-targeted medication after a PAH diagnosis between 1/1/2015-12/1/2023. The index date was the date of the first qualifying prescription. Patients were required to have a right heart catheterization within six months prior to index date and no evidence of Group 2-5 PH between 1/1/2014-12/1/2023. Patients were followed from index date until the earliest of increase in number of CPCs, change in treatment, end of data availability, or death. Outcomes included all-cause HCRU by setting of care and all-cause mortality. A cost analysis is also underwayfor patients with linked claims. Results were stratified by number of CPCs measured in the 12 months prior to index date. Analyses were descriptive only; outcomes were assessed on a person-month basis. Results The sample consisted of 874 patients, and over 60% had at least one CPC. Length of follow-up was similar across patient groups. Patients with more CPCs were older, more likely to be on monotherapy and greater chance of being male. The rate of all-cause HCRU and outpatient visits was highest in patients with 3+ CPCs. However, the average length of hospitalization was shorter among patients with 3+ CPCs. The all-cause mortality rate overall was 1.9 per 100 person-month, and the rates were higher in patients with a higher number of CPCs. Conclusions This study found that over two thirds of patients diagnosed with PAH in the US have CPCs. Patients with more CPCs faced a higher burden of HCRU and mortality. The burden of HCRU and mortality increased with a higher number of CPCs, highlighting the need for multidisciplinary care to optimize outcomes.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive debilitating disease that disproportionately impacts young women. The aim of this study is to explore caregiver networks and support around these women. METHODS: This is an interim descriptive analysis of data from an online survey of women (age 21-50) with PAH living in the US and UK. De novo questions and validated instruments of social support and interpersonal support evaluation were included in the survey. Institutional Review Board/Ethics Committee exemption was obtained in all countries. Final analysis which includes ∼120 more patients from Canada, Germany, France, and Italy will be available for presentation at the conference. RESULTS: This analysis includes 150 women patients (US=120, UK=30). Regarding the make-up of informal caregiver networks, in the US patients most frequently reported spouses (58%), children (53%) and friend(s) (51%) as their caregivers, while in UK patients most frequently reported spouse (53%), relatives (30%) and parent(s) (23%). In the US patients required support from their spouse almost every day to provide financial support (49%), check in how they were doing (46%) and household duties (47%), while in the UK patients required support almost every day with household duties (25%), taking care of important people in life (31%) and making efforts to cheer up the patient (31%). Participants were asked to indicate the amount of support they needed versus the amount of support they receive. In the past four weeks patients reported ‘needing support' with household duties, 88% (US) and 100% (UK); caring for their parents and children, 64% (US) and 83% (UK); and finances, 72% (US) and 67% (UK). Patients reported ‘having reliable support’ with household duties, 88% (US) and 87% (UK); caring for their parents or children, 79% (US) and 90% (UK); and finances 72% (US) and 90% (UK). CONCLUSIONS: This study highlights that women with PAH require a strong network of caregivers and most burden of caregiving falls on family members. Despite these networks of care, there may be areas where more support is needed. Further research is warranted to investigate areas where patients don't have full coverage from their informal caregiver network and explore to what extent these patients are linked to formal support programs to cover those needs.

There is considerable evidence that medication non-adherence is associated with higher healthcare costs. Payers and providers often target adherence quality measures for intervention, but the impact may depend on the medication. This study sought to assess differences in the relationship between medication adherence and medical (i.e., non-pharmacy) costs across three quality measures in a Medicare Advantage sample. An observational study was conducted among cohorts of Medicare Advantage beneficiaries using the 2018-19 Optum’s de-identified Clinformatics® Data Mart Database. Cohort assignment was based on inclusion in one or all three of the Pharmacy Quality Alliance’s adherence measures for (1) renin-angiotensin-system antagonists, (2) statin, and (3) diabetes medications. Medication adherence was measured in year 1 and payer medical costs were measured in year 2. Generalized linear modeling (Gamma distribution and a log link) with interaction terms and coefficient contrasts were used to assess the relationship between adherence and subsequent payer medical costs, and to evaluate differences in this relationship across the three measures. Analyses were adjusted for sociodemographic, clinical, prescription-related, and insurance-related variables. The single-measure cohort included 1,001,316 beneficiaries, and the three-measure cohort consisted of 284,137 beneficiaries. There were negative relationships (p < 0.0001) between adherence and payer medical costs for all medication classes. These associations were stronger for diabetes medications (0.9808; p < 0.0001), followed by renin-angiotensin-system antagonists (0.9874; p < 0.0001) and statin medications (0.9919; p < 0.0001) in the single-measure cohort. The findings were similar among beneficiaries using all three medication classes. Better adherence was associated with lower payer medical costs across several therapeutic areas, providing additional evidence of the importance of adherence in managing health care costs. The relationship between adherence and subsequent year medical costs appears stronger for diabetes medications relative to renin-angiotensin-system antagonists or statins. Further research may explore interventions to increase adherence to diabetes medications to improve diabetes management.

BACKGROUND:The Centers for Medicare and Medicaid Services (CMS) Star Ratings program incentivizes health plans in Medicare to improve performance on a variety of quality measures such as adherence to renin-angiotensin system antagonists (RASAs). Adherence to RASA medications, defined as having a proportion of days covered (PDC) of at least 80%, has been improving for several years, suggesting that further investigation is needed to assess the appropriateness of the current 80% PDC threshold for medication adherence as an indicator of quality. The 80% PDC threshold has been found to be associated with improved health care resource utilization outcomes; however, little evidence exists to show that this threshold is optimal. OBJECTIVE:To evaluate the association between adherence to RASA medications and health care resource utilization outcomes within a Medicare Advantage population and to identify the optimal PDC threshold that maximizes economic and utilization benefits. METHODS:This retrospective cohort study used de-identified administrative claims data from the 2015 to 2018 in Optum's de-identified Clinformatics Data Mart Database. Inclusion in the study was based on measure specifications for the RASA adherence measure used in the Medicare Part D Star Ratings program. Adherence was assessed over a 1-year period, and health care utilization and medical costs were assessed in the subsequent year. Multivariable logistic regression models were used to assess the relationship between adherence and economic outcomes after accounting for hypothesized confounders. RESULTS:A total of 1,006,901 individuals were included in the study with an average PDC of 87.5% (SD = 17.8%). During the follow-up period, 12.1% of individuals experienced a hospitalization, 14.81% used an emergency department (ED), and 32.3% visited a non-ED outpatient facility. Each percentage point increase in PDC was significantly associated with decreased odds of hospitalization (odds ratio [OR] = 0.997; 95% CI = 0.997-0.997) and ED visit (OR = 0.997; 95% CI = 0.996-0.997), being in the top decile of payer medical costs (OR = 0.998; 95% CI = 0.997-0.998), and increased odds of outpatient visits (adjusted OR = 1.001; 95% CI = 1.001-1.002). Receiver operator characteristic curve analyses found the optimal PDC thresholds to be 91.5%, 90.7%, 90.7%, and 90.4% for hospitalization (area under the curve [AUC] = 0.527), ED visit (AUC = 0.534), outpatient visit (AUC = 0.501), and medical costs (AUC = 0.532), respectively. CONCLUSIONS:This study demonstrated the importance of medication adherence for preventing undesirable outcomes, such as future hospitalizations, ED visits, and high medical costs, among individuals with hypertension enrolled in Medicare Advantage. The optimal threshold for PDC related to health care resource utilization outcomes was found to be greater than that used in the measure in CMS Star Ratings. Future research should examine the impact of changes in adherence thresholds for economic and clinical outcomes.

Rationale: Pulmonary Arterial Hypertension (PAH) is a progressive and debilitating disease for patients and a high burden on caregivers. The comprehensive impact of PAH on health-related quality of life (HRQoL), economic stability, and the downstream societal burden remains poorly understood. We described the impact of PAH on work productivity, daily activities, HRQoL, and caregiving in the United States (US). Methods: Between September-October 2024 a prospective, cross-sectional survey was fielded in a nationally representative sample of patients from a US rare disease panel aged ≥18 years with self-reported PAH diagnosis (World Health Organization Group 1 PH), right heart catheterization, and at least one PAH-targeted therapy. The scientific questionnaire included: EQ-5D index score, EQ-5D Visual Analogue Scale (VAS), Work Productivity and Activity Impairment (WPAI) scale, and customized survey items to assess treatment burden and caregiver support needs. The study was IRB exempt. Analyses were descriptive. Results: As of this 7 October interim analysis, 155 respondents completed the survey (mean age=51.6; female=93.5%, White=80%). Most reported functional class II (45.2%) or III (40.6%). The proportions who reported mono, dual, triple, or more than 3 therapies were 13.5%, 31.0%, 41.3%, and 14.2%, respectively. Scores (mean ± standard deviation) for EQ-5D were 0.63 ± 0.22 [scale: 0=dead to 1=full health] and for EQ-5D VAS were 63.1 ± 17.5 [scale: 0=worst to 100=best], indicating substantial impact on quality of life. PAH affected respondents’ ability to work, with 41.3% changing from full- to part-time employment and 49.0% decreasing their work hours. Among those currently employed (29.7%), in the past 7-days 17.2% ± 26.7 missed work and 36.7% ± 22.3 reported suboptimal functioning while at work. Nearly all (n=133, 85.8%) respondents had a caregiver to help with daily activities. Among those with at least one caregiver the most common caregivers were unpaid: partner/spouse (76%), followed by children (59%), and friend/neighbor (53%). Caregivers frequently missed work to assist patients with daily activities. Proportionally, partners/spouses missed work the most (59.4%), followed by other family members (32.3%), and children (28.2%). For patients with paid caregivers (n=15, 9.7%), out-of-pocket costs per month ranged from $0 to $100. Results will be presented by functional class. Conclusions: PAH detracts from both patient and caregiver quality of life, decreasing daily functional capacity and economic productivity. Early findings quantify this burden and underscore the potential importance of programs to alleviate both the medical and socioeconomic burden of PAH on patients and their families.

Pulmonary arterial hypertension (PAH) is a highly progressive disease characterized by luminal narrowing of the pulmonary arteries, leading to progressive dyspnoea and restricted functional capacity, which can ultimately result in right ventricular failure and death. Treatment goals include improving functional class and walk distance, recovering right ventricular function, halting disease progression, and improving survival. PAH carries a high mortality rate, and treatment escalation is a common feature of disease management. Due to the substantial impact of PAH, a high economic burden has been observed. A systematic literature review (SLR) was carried out to assess the contemporary economic burden of PAH, including the impact of disease severity and treatment escalation. An electronic database search was conducted and supplemented with a hand search of health technology assessments and conference materials. Studies were included from 2012 to 2024, with no restrictions on geographical location. The inclusion criteria specified that adult patients with PAH (≥ 18 years) and only English language studies were captured. The review included 148 studies and evaluations, 110 of which were observational studies, 14 were economic evaluations, and 24 were health technology assessments. The studies identified reported on several healthcare resource utilization (HCRU) outcomes including hospitalization, PAH-related hospitalization, inpatient visits, emergency department (ED) visits, intensive care unit (ICU) visits, and outpatient visits. Cost data were also reported, including total costs and costs for each of the above-mentioned types of HCRU, as well as specific costs such as pharmacy and drug costs. The results provide an overview of the high economic burden caused by PAH, indicating that the economic burden increases with increasing severity; reported mean monthly costs were as high as US 14,614 (cost converted to USD 2024) for the highest severity group. These data also demonstrated the impact of PAH-specific therapies in reducing HCRU, with efficacious treatment shifting management from an inpatient to outpatient setting (i.e., reduced inpatient admissions and length of stay). Further, while treatment escalation resulted in increased pharmacy costs, this was offset by a reduction in HCRU, including hospitalizations and ED visits. Timely diagnosis was also associated with reduced economic burden, as patients with a longer delay prior to diagnosis reported a higher mean number of monthly hospitalizations, ICU stays, and ED visits. Functional limitation is a common feature of PAH disease progression and can severely impact a patient’s ability to work. This SLR identified few studies that investigated such outcomes as well as broader indirect costs, such as out-of-pocket costs and productivity loss. This study highlights the considerable economic burden associated with PAH, which is particularly evident for HCRU, and the importance of effective disease management in reducing this burden. Additionally, these findings demonstrate the economic value of treatment escalation and suggest higher drug costs can potentially be offset through improved patient outcomes and associated reductions in HCRU.

ObjectiveThis mixed methods study examines the relationship between outcome expectations, self-efficacy, and self-care behaviors in individuals with type 2 diabetes (T2DM). It also explores the personal values motivating these behaviors through in-depth interviews.MethodsAdults with T2DM (n = 108, M age = 57 years, 58% female, 48% Black) completed questionnaires and participated in in-depth interviews using a laddering technique.ResultsOrdinary least squares regression models were used to analyze the relationships between self-efficacy, outcome expectations, and four self-care behaviors (physical activity, dietary choices, blood glucose monitoring, and medication usage). The findings indicate that self-efficacy is significantly and positively associated with diet and physical activity. Both outcome expectations for blood glucose testing and self-efficacy are significantly and positively associated with self-reported monitoring. However, neither outcome expectation nor self-efficacy is associated with medication usage. The in-depth interviews revealed three common values related to self-care behaviors: maintaining health and longevity, agentic values of self-control, achievement, and self-esteem, and a sense of belonging.ConclusionsThis study sheds light on the complexity of diabetes self-management, offering insights into individuals' values, behavioral strategies, and the influence of control perceptions on this relationship, revealing both differences and commonalities in stated values.Practice ImplicationsBy understanding how personal values drive diabetes self-care behaviors, practitioners can assist patients in establishing meaningful connections between their values and the challenges of living with diabetes.

BACKGROUND:A comprehensive medication review (CMR) is an annual service offered to eligible Medicare Part D beneficiaries as a component of the Medication Therapy Management program. However, little is known about the most meaningful aspect of CMRs from the patient's perspective. This information is necessary to help improve the service. OBJECTIVE:To conduct concept elicitation interviews with patients who recently received a CMR to guide quality improvement efforts. METHODS:Those who recently received a telephonic CMR were invited to participate in semistructured interviews to provide their insights on the CMR service. An interview guide was used and contained the following 6 key questions (with additional probing questions) exploring: (1) overall experience, (2) medication knowledge, (3) concerns, (4) management, (5) satisfaction, and (6) experience. Interviews were transcribed and analyzed thematically. RESULTS:Interviews were conducted with 42 patients and resulted in the identification of themes related to the CMR service that were most meaningful to patients. The resulting framework contained 3 themes related to the content of the CMR (eg, medication review), the characteristics of the pharmacy professional (eg, professionalism), and the interaction during the CMR (eg, the telephonic experience). Intrinsic patient factors (eg, prior experiences) were also identified as important to contextualize patients' experiences. CONCLUSIONS:The framework provides concrete examples of the need for continued quality improvement of the CMR service and can be illustrated using the structure-process-outcome model. Patient perspectives should be accounted for in future quality improvement activities.

Medication therapy management (MTM) services include comprehensive medication reviews (CMRs), which have been com-pleted with millions of patients since their inception in the United States. The current MTM quality measure focuses on whether CMRs were completed (ie, the CMR comple-tion rate). However, this process measure does not assess quality of care, or patient -reported or other outcomes of CMRs, and, therefore, does not reward MTM provid-ers for improving health outcomes. In this viewpoint article, we present 3 reasons that shape our argument for new MTM quality measures and offer recommendations on next steps to achieve this.

Introduction: Medicare Advantage Part D plans and stand-alone Part D prescription drug plans are required by the Centers for Medicare and Medicaid Services to have qualified providers, including pharmacists, and offer annual comprehensive medication reviews (CMRs) for eligible Medicare beneficiaries. Although guidance on the components of a CMR is available, providers have flexibility in how to deliver the CMR to patients and which content to cover. With the variety of patient needs, CMR content is not always consistently delivered in practice. Our research group performed an extensive evaluation to create and test an ideal CMR content coverage checklist for CMR provision.CMR Content Checklist: The CMR Content Checklist can be used for quality improvement purposes to evaluate the comprehensiveness of pharmacist servicesdto assess either within pharmacist variation across patients or within organization variations between pharmacists or sites.Incorporating the CMR Content Checklist into practice: Testing in a real-world setting demon-strated where gaps in service coverage existed. The CMR Content Checklist could be used as the first step for quality improvement given that it provides details on the key aspects of the service that can inform quality measure development.(c) 2023 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

Aims: To explore the associations between social determinants of health and patient-centred outcomes among adults with chronic heart failure with reduced ejection fraction.Design: Cross-sectional online self-report survey.Methods: A survey assessing social determinants of health (demographics, socio-economic position, affordability of care and social support) and patient-centred outcomes, including the Kansas City Cardiomyopathy Questionnaire-12 and validated measures of medication adherence, treatment satisfaction, treatment burden and mental health, was completed by 512 adults with chronic heart failure with a reduced ejection fraction between 06 March and 29 June 2020. Multivariable analyses included linear and logistic regression.Results: Female gender, having a care partner, and being offered financial assistance with medications were associated with worse health status, while perceiving medication as affordable and being married were associated with better health status. Females and having Medicaid, dual Medicaid/Medicare or no medical insurance were associated with a higher likelihood of depression, and non-white race/ethnicity was associated with less depression. Medication adherence was lower in patients having a care partner and offered financial assistance. Patients being offered financial and medication management assistance were more likely to be overwhelmed by the treatment burden, whereas those having some college education were less so.Conclusions: Social determinants of health are associated with patients' disease-specific health status, mental health and treatment satisfaction and burden. These findings underscore the importance of assessing social determinants of health in clinical practice and the need for developing and testing novel strategies to determine whether they improve patients' health.Impact: The relationship between social determinants of health- and patient-centred outcomes was assessed; affordability of care and social support factors were most strongly associated with outcomes for patients with chronic heart failure and reduced ejection fraction, underscoring the importance of assessing social determinants of health in routine clinical care.Implications for the profession and/or patient care: Social determinants of health data could potentially inform care delivery for patients with heart failure and reduced ejection fraction by helping to identify those who require additional support to manage their symptoms, access care and adhere to treatment. Social support and affordability of treatment were associated with most patient-centred outcomes, suggesting these factors may provide clinicians with an indicator of a patient's level of general well-being that could be assessed during routine follow-up care.Reporting method: This research followed the STROBE checklist for cross-sectional studies.Patient or public contribution: Adults who have heart failure with reduced ejection fraction that consented to participate in the study provided the data used for all analyses reported on in the manuscript. Service users, caregivers or members of the public had no involvement in the study.

Background Comprehensive medication reviews (CMRs) are offered to eligible Medicare beneficiaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear. Objective To qualitatively assess CMR content and delivery among telephonic CMR providers. Methods This qualitative thematic analysis used transcriptions of audio-recorded patient interactions during CMRs from 3 telephonic medication therapy management provider organizations. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha. Results Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/cost; identity/privacy/recording; and patient’s medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assessment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: documentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered. Conclusion These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among organizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining flexibility for pharmacists to provide patient-oriented CMRs that meet patients’ clinical needs.

Background: Although comprehensive medication review (CMR) services have been shown to provide value to patients and payers, the extent of uniformity in service delivery is unknown. A variety of standards and recommendations are available from academic and professional sources, but variation in service provision is an important consideration when attempting to measure or compare service quality nationally. Objective: This study aimed to identify and summarize trends in the peer-reviewed and gray literature describing telephonic CMR delivery and content. Methods: A scoping review of peer-reviewed and gray literature was conducted to quantify and qualify trends in CMR service. Two independent reviewers screened abstracts from 9 bibliographic databases and selected gray literature sources in accordance with the Joanna Briggs Institute guidelines and an internally developed protocol. Inclusion criteria for the review were English language; discussion of telephonic CMR service in the United States; research, legislation, or guidelines that describe CMR content coverage requirements for payment; and publication from the year 2000 to the present. Data relating to publication type, study design, setting, region, and themes of CMR content were collated into a Microsoft Excel data extraction form. Qualitative thematic analysis was conducted, and key findings and concepts were reported contextually. Results: Of 374 identified documents screened, 15 were included in this scoping review and thematic analysis. The following characteristics of CMRs were identified: content, coverage, eligibility, frequency, process, and responsiveness. All published documents (n = 15, 100%) included a discussion of CMR content, and 14 sources (93%) addressed process elements of providing a CMR. Discussion of other themes varied in frequency across documents, ranging from 3 articles (20%) addressing organizational goals for CMR to 12 articles (80%) including elements of responsiveness. Within-theme variation was also observed for several CMR content areas. CMR process was the most heterogeneous theme with topics ranging from access to patient health records to pharmacist training. Conclusions: Assessment of telephonic CMR comprised a small but steadily increasing portion of the medication therapy management literature. Publications since 2015 have shown an increasing consensus of CMR content and purpose. Per the identified literature, there is an ongoing demand for higher-quality, more holistic CMRs, but there is no consensus on how to measure CMR quality. Future work should include engaging with CMR experts to understand variability in measures of CMR success. (C) 2022 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

BACKGROUND:Comprehensive medication reviews (CMRs) are provided by providers such as pharmacists to eligible beneficiaries. Although CMRs have been shown to provide value to patients, little is known about the service uniformity, quality, and content of CMRs. OBJECTIVE:This study aimed to characterize the current state of CMR services from diverse stakeholder perspectives and describe variation in responses to content and delivery of telephonic CMR services. METHODS:Semistructured interviews were conducted with 10 key informants. The interview guide contained 6 key questions with additional probing questions. Transcripts were analyzed using the inductive saturation model and phenomenological approach to code emergent themes, which were iteratively refined until saturation was achieved. RESULTS:Key informants included CMR payers (n = 3), providers (n = 5), and standards-setting organizations (n = 2). Ten themes about CMRs emerged from qualitative analysis: (1) definition, (2) organizational goals, (3) content, (4) eligibility, (5) frequency, (6) acceptance and completion, (7) process and personnel, (8) quality assurance, (9) preparation, and (10) future directions. CMR content descriptions were consistent across perspectives. Key informants described scenarios appropriate for expanded CMR eligibility criteria, although none were consistently reported. Providers emphasized patient CMR acceptance rates whereas payers and standard-setting organizations emphasized completion rates. Completion rates and adherence to Centers for Medicare and Medicaid Services standards were characterized as core organizational goals (n = 8), whereas patient satisfaction was less frequently identified (n = 4). A lack of incentive for CMR providers to follow-up with patients was a barrier to expanded services. Overall, key informants were dissatisfied with the CMR completion rate measure and would prefer measures focused on service quality and outcomes. CONCLUSIONS:CMR services largely met perceived guidelines, with variation in value-added services. Key informants desired adoption of an actionable measure that is focused on quality rather than completion rate. To inform a quality measure, future research should analyze completed CMRs to determine the extent of variation in content and delivery.

Diabetes self-management is a complex process in which individuals are asked to modify established health behaviors. Healthcare providers are instrumental in enhancing individual self-management and are encouraged to consider the patient perspective, often expressed indirectly. Using multidimensional analysis, this study analyzed talk to compare linguistic features used by adherent and non-adherent individuals with diabetes. In-depth telephone interviews were conducted with 108 individuals. Recruitment was stratified by sex, race and glycated hemoglobin (A1C) score. Interviewer contributions were removed from the transcripts, leaving only the participants’ contributions. Using A1C score (?7%, >7%) the texts were divided into adherent and non-adherent datasets. Based on computer-assisted, quantitative analysis, ten linguistic features had a significant difference in frequency of use between the two groups. The participants in the adherent group used a greater frequency of linguistic features related to personal stance than the non-adherent group, and these expressions of personal stance were considered in relation to the participant’s sense of agency. A better understanding of the way in which different subsets of individuals talk about diabetes self-management would facilitate greater healthcare provider understanding of the patient’s perspective during clinical encounters to improve adherence.

Supplemental Digital Content is available in the text Abstract Limited evidence exists regarding the relationships between adherence, as defined in Pharmacy Quality Alliance (PQA) medication adherence measures, health care utilization, and economic outcomes. PQA adherence measures for hypertension, cholesterol, and diabetes are of particular interest given their use in Medicare Star Ratings to evaluate health plan performance. The objective of this study was to assess the relationship between adherence and utilization and cost among Medicare Supplemental beneficiaries included in the aforementioned PQA measures over a 1-year period. Retrospective cohort study. Three cohorts (hypertension, cholesterol, and diabetes) of eligible individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009–2015) were used to assess associations between adherence and health care expenditure and utilization for Medicare Supplemental beneficiaries. Generalized linear models with log link and negative binomial (utilization) or gamma (expenditure) distributions assessed relationships between adherence (≥80% proportion of days covered) and health care utilization and expenditure (in 2015 US dollars) while adjusting for confounding variables. Beta coefficients were used to compute cost ratios and rate ratios. Adherence for all 3 disease cohorts was associated with lower outpatient and inpatient visits. During the 1-year study period, adherence was associated with lower outpatient, inpatient, and total expenditures across the cohorts, ranging from 9% lower outpatient costs (diabetes cohort) to 41.9% lower inpatient costs (hypertension cohort). Savings of up to $324.53 per member per month in total expenditure were observed for the hypertension cohort. Our findings indicate adherence is associated with lower health care utilization and expenditures within 1 year.

BACKGROUND: Diabetes is a prevalent chronic condition in the United States that results in considerable morbidity and mortality, frequent use of the health care system, and high health care expenditures. Adherence to antidiabetic medications can help improve health outcomes and lower health care utilization and expenditures. The Pharmacy Quality Alliance (PQA) Proportion of Days Covered (PDC): Diabetes All Class medication adherence measure was developed and endorsed to improve adherence to noninsulin antidiabetic medications; however, it has not been assessed in a commercial population of diabetes patients over a 1-year time frame. OBJECTIVE: To determine the association between adherence, as defined in the PQA medication adherence measures, and health care utilization and expenditure among commercially insured individuals using antidiabetic medications. METHODS: This 1-year retrospective study evaluated a cohort of individuals from IBM MarketScan Research Databases (2009-2015) with noninsulin antidiabetic medications. Eligible study subjects included adults (aged ≥ 18 years at index date) with continuous enrollment in their health plans for 6 months before (i.e., baseline period) and 12 months after (i.e., study period) the index date and ≥ 2 prescriptions dispensed for any medication included in the PQA PDC Diabetes All Class medication adherence measure, with at least 150 days between the first and last fill during the study period. The index date was defined as the first fill for a medication included in the PQA PDC Diabetes All Class adherence measure after a 180-day baseline period. Generalized linear models with log link and gamma distribution (expenditure) or negative binomial distribution (utilization) assessed relationships between adherence (≥ 80% PDC) and health care utilization and expenditure while adjusting for potential confounders. Cost ratios (CR) and rate ratios (RR) were computed using beta coefficients. Cohort characteristics were compared using t-tests, Wilcoxon rank sum tests, or chi-square tests with an alpha level of 0.001 set a priori. RESULTS: A total of 1,576,112 individuals were eligible; of these, 1,028,176 (65.2%) were adherent. Significant differences in demographic characteristics were observed between adherent and nonadherent groups (P < 0.001). Multivariable analyses demonstrated that adherence was associated with the following: (a) 16.6% fewer inpatient (RR = 0.834, 95% CI = 0.819-0.850) and 3.6% more outpatient service visits (RR = 1.036, 95% CI = 1.032-1.039) and (b) 16.8% lower inpatient expenditures (CR = 0.833, 95% CI = 0.829-0.836); 2.6% lower outpatient expenditures (CR = 0.974, 95% CI = 0.970-0.978); 16.4% higher prescription drug expenditures (CR = 1.164, 95% CI = 1.159-1.169); and 4.2% lower total (CR = 0.958, 95% CI = 0.954-0.962) expenditures. Adherent subjects were associated with lower incremental per member per month expenditures for inpatient (-$31.74), outpatient (-$10.09), and total (-$30.82) expenditures, yet higher prescription drug expenditures ($25.60) compared with nonadherent subjects. CONCLUSIONS: Adherence to noninsulin antidiabetic medications was associated with more outpatient and fewer inpatient visits, as well as lower total expenditures compared with nonadherence. DISCLOSURES: Funding was provided by grants from Pharmacy Quality Alliance, Merck & Co. (Kenilworth, NJ), and SinfoniaRx. In addition, Chinthammit reports personal fees from Eli Lilly and Company, outside the submitted work. Axon reports grants from the American Association of Colleges of Pharmacy and the Arizona Department of Health Services, outside the submitted work. Taylor reports grants from the Arizona Department of Health Services, outside the submitted work. Warholak reports grants from Novartis and the Arizona Department of Health Services, outside the submitted work. Chinthammit and Campbell disclose that this work was completed during their employment at the University of Arizona. This research was presented as a poster at the AMCP Annual Meeting 2019; March 25-28, 2019; San Diego, CA.

BACKGROUND: Adherence to medication, and related health and economic outcomes, is becoming increasingly important as populations age and as the number of Americans managing chronic conditions increases. The Pharmacy Quality Alliance (PQA) statin medication adherence measure is used in Medicare star ratings to evaluate health plan performance. Yet, limited evidence exists that investigates the association between statin medication adherence, as specified in the PQA adherence quality measure, and disease-state control, health care utilization, and costs. OBJECTIVE: To determine the association between adherence (≥80% proportion of days covered) and disease-state control, health care utilization, and health care costs for Medicare supplemental beneficiaries using statin medications eligible for inclusion in the PQA statin adherence quality measure. METHODS: This retrospective study used a cohort of eligible beneficiaries for inclusion in the PQA statin adherence measure with low-density lipoprotein (LDL) laboratory values from IBM MarketScan Medicare Supplemental Research Databases (2009-2015). A logistic regression model assessed the association between adherence and LDL control (controlled individuals had LDL levels ≤ 100 mg/dL). Health care utilization and costs during a 1-year period, from first statin medication claim, were compared between adherent and nonadherent groups using generalized linear models with log link and negative binomial distribution (utilization) or gamma distribution (costs), adjusting for covariates. Beta coefficients were used to compute cost ratios (CR) and rate ratios (RR). Cohort characteristics were assessed using t-tests, Wilcoxon rank sum tests, or chi-square tests. An a priori alpha level of 0.001 was used. RESULTS: The study cohort consisted of 77,174 beneficiaries, of whom 58,668 (76.0%) were classified as adherent to their statin medications. After controlling for other factors, odds of disease-state control were approximately 2 times higher among medication adherent beneficiaries compared with their nonadherent counterparts (OR = 2.192; 95% CI = 2.109-2.278). Multivariable analyses showed adherers experienced 4.7% fewer outpatient (RR = 0.953; 95% CI = 0.940-0.965) and 27.5% fewer inpatient (RR = 0.725; 95% CI = 0.687-0.766) visits; had 9.9% lower outpatient (CR = 0.901; 95% CI = 0.885-0.916) and 28.3% lower inpatient (CR = 0.717; 95% CI = 0.705-0.729) costs; 14.7% lower total costs (CR = 0.853; 95% CI =0.838-0.868); and 7.0% higher prescription drug costs (CR = 1.070; 95% CI = 1.052-1.089) than nonadherers. Adherence to statin medications was associated with a reduction in total costs of $157.32 per member per month. CONCLUSIONS: This retrospective database analysis demonstrated that statin adherence was associated with approximately twice the odds of having a controlled disease state compared with nonadherence in a large Medicare sample. Adherent beneficiaries had fewer outpatient and inpatient visits (lower utilization), lower outpatient and inpatient costs, and lower total costs, a calculated savings of $157.32 per member per month, despite having higher prescription drug costs. Finally, these results provide important new information by demonstrating that adherence (≥ 80%) is associated with lower health care costs in a short (1-year) time frame. DISCLOSURES: Funding for this study was provided by Pharmacy Quality Alliance; Merck & Co. (Kenilworth, NJ); and SinfoniaRx. All authors except Pickering and Black were employed by the University of Arizona College of Pharmacy or the Mel & Enid Zuckerman College of Public Health at the time of this study. Pickering is employed by the Pharmacy Quality Alliance, and Black is employed by Merck & Co. Chinthammit also reports employment with Eli Lilly and Company, and Campbell reports employment with the Pharmacy Quality Alliance. Axon reports grants from Arizona Department of Health Services, unrelated to this work. Warholak reports grants from Novartis and the Arizona Department of Health Services, unrelated to this work. This research was presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual Meeting 2019, May 18-22, 2019, in New Orleans, LA.

Background Medication non‐adherence can result in considerable morbidity, mortality, and costs. The Pharmacy Quality Alliance hypertension medication adherence measure is used by US healthcare payers and providers to assess renin‐angiotensin system antagonist medication adherence. However, associations between renin‐angiotensin system antagonist adherence as calculated in quality measures, and healthcare service use and expenditure in commercial populations over a 1‐year timeframe has not been assessed. Methods and Results This retrospective cohort study used eligible commercially insured individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009–2015). Generalized linear models with log link and gamma distribution (expenditure) or negative binomial distribution (usage) assessed relationships between hypertension adherence (≥80% proportion of days covered) and healthcare use and expenditures (in 2015 US dollars) while adjusting for covariates (age, sex, geographic region; health plan; Deyo‐Charlson Comorbidity Index, number of chronic medications, and treatment naivety). Beta coefficients were used to compute cost ratios and rate ratios. A total of 4 842 058 subjects were eligible; of those, 3 310 360 (68%) were adherent (adherent mean age 53.3±8.0 years, 55.9% men; non‐adherent mean age 50.3±9.1 years, 53.1% men). Adherence was associated with fewer inpatient (rate ratios, 0.612; 95% CI, 0.607–0.617) and outpatient visits (rate ratios, 0.995; 95% CI, 0.994–0.997); and lower total costs (cost ratios, 0.876; 95% CI, 0.874–0.878) compared with non‐adherence. Adherence was associated with lower average per member per month total costs ($97.98) compared with non‐adherence. Conclusions Adherence to renin‐angiotensin system antagonists was associated with fewer outpatient and inpatient visits, and lower total costs compared with non‐adherence in a 1‐year time frame.