Proportion of patients with diabetes in adherence to medication regimens
The purpose of this performance measure is to assess rates of medication adherence among adult patients with diabetes, as an intermediate effect of interventions to increase implementation of quality improvement processes, team-based care in health systems, and the use of health-care extenders to support self-management, such as community pharmacists and community health workers.
Rigorous reviews have found that adherence among persons with chronic diseases in developed countries averages only 50% (WHO 2003). Estimates for medication adherence rates among people with diabetes vary widely (31% to 98%), but most suggest substantial room for improvement (Cramer 2008, Odegard 2007, Rubin 2005). Nonadherence to diabetes medications is associated with poorer glycemic control and increased hospitalizations, health care costs, and mortality (Ho 2006, Odegard 2007, Salas 2009, Sokol 2005).
In low income populations, competing needs compound the challenges of improving health, including the problem of medication adherence (WHO 2003). Even within an insured population, disparities have been found in rates of cost-related medication underuse, with African Americans and Latinos more likely than whites and Asian/Pacific Islanders to report using less medication because of cost (Tseng 2008). Higher rates of cost-related medication underuse are also found among Medicaid recipients than among those with Medicare or private insurance (Piette 2004).