Psychosocial Determinants of Statin Medication Adherence

ABSTRACT While the effectiveness and benefits of statin medications have been demonstrated in numerous studies, adherence to statin therapy is still less than optimal. Psychosocial factors are attributed to a variety of health behaviors, but the study of their impact on statin medication adherence is limited. This study aimed to (1) investigate the effect of self-regulatory mechanisms impacting patients’ adherence to statin medications, (2) assess the effect of a regulatory fit intervention on the behavior, and (3) investigate how optimism may play a role in adhering to statin medications. Adults taking a statin medication were recruited from a Midwestern University health system and were randomized into two study groups. Each study group was primed with messages that were framed either as promotion or prevention; another randomization followed into three groups for each. Patients were primed with implementation intentions framed as promotion or prevention and one group served as the control receiving no implementation intentions. The Regulatory Focus and Fit Theories were used to design the intervention. The behavior of statin medication adherence and patient psychosocial factors were assessed via a series of questions delivered in two questionnaires two weeks apart. Conditional indirect processing models were designed to test the relationships between the psychosocial factors and the behavior of statin medication adherence. A total of 326 patients completed both surveys. Patients’ prevention compared to promotion orientation positively and significantly impacted the behavior of statin medication adherence directly and indirectly via behavioral intentions and motivational intensity. At weak patient psychosocial factors, the Fit intervention resulted in higher statin medication adherence levels compared to the non-fit or control groups. Patients’ optimism levels positively impacted the behavior of statin medication adherence by significantly influencing behavioral intentions and motivational intensity, when levels of self-efficacy and outcome expectations were low or moderate. Patient psychosocial factors present an area of opportunity to explain the behavior of medication adherence and design interventions that will motivate patients to successfully engage in medication adherence. Future studies are needed to further investigate the effect of these and other psychosocial factors in a variety of medications and populations.PHDSocial and Administrative SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/137050/1/iaconi_1.pd

Toward Continuous Primary Care in the United States

Background : As stated by Donabedian, the father of quality assurance, satisfaction is an integral component of quality in medical care. Patient satisfaction is an important predictor of health-related behaviors, use of medical services, and health outcomes. Impressive literature exists in examining various aspects of patient satisfaction, however, no study thus far has examined differences in patient satisfaction between first and return visits to primary care physicians. Objective : Our interest is to determine whether there are differences in patient satisfaction between first and return visits to primary care physicians, with the hypothesis that patients returning for their visits have a higher satisfaction level compared to their first initial visit. Methods : The authors conducted a cross-sectional analysis of the national Web-based survey DrScore. Via DrScore, patients anonymously rated their physician on the basis of treatment satisfaction received from their most recent outpatient visit. The association between physician satisfaction and total care patient ratings of first and return visits was assessed via regression analysis. Results : In total, 15,341 patients were included in this study. Our findings indicate that for a 1-unit change from first visit to return visits, the coefficient of patient satisfaction for the return visits is approximately 10 times higher compared to that of the first visit. Furthermore, the mean satisfaction score for the return visit group is higher than that for the first visit group, 80.28 versus 64.48, respectively ( P < .05). Conclusion : Return visits to primary care physicians are associated with higher patient satisfaction compared to the first initial visit

Medicaid Payment Mechanisms: Impact on Medication Adherence and Health Care Service Utilization in Type 2 Diabetes Enrollees

Abstract The purpose of this retrospective cohort study was to examine the impact of the type of health plan (capitated vs. fee for service [FFS]) on outcomes (medication adherence and health care service utilization) in type 2 diabetes Medicaid enrollees. Subjects were 8581 Medicaid enrollees with type 2 diabetes who newly started oral pharmacotherapy and were followed for 6 months before and 12 months after the index antidiabetic medication to collect data on medication adherence and health care service utilization. Multiple log-linear regression analysis was used to predict medication adherence while negative binomial regressions were used to examine health care service utilization. Medication adherence was found to be significantly lower for patients in capitated plans (5%, P?<?0.05). Moreover, patients in capitated plans were associated with 14% more hospitalizations and 16% increased odds of emergency room visits, but 27% fewer outpatient visits compared to those in FFS plans (all P?<?0.05). Although Medicaid programs use capitated managed care plans primarily as a cost-containment strategy, these plans may not be cost-effective for the long-term management of chronic conditions such as diabetes. (Population Health Management 2010;13:209?218)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85126/1/pop_2009_0046.pd