The effectiveness of care coordination on medication adherence among high-need, high-cost commercially insured beneficiaries: A randomized controlled trial
Abstract
Background: High-need, high-cost (HNHC) beneficiaries experience life stressors that complicate their medication self-management. Care coordination programs may improve medication-taking behavior, including for chronic conditions that require daily medication adherence.
Objective: To determine whether nurse-led care coordination is associated with improved adherence among an HNHC commercial population with a chronic condition.
Methods: We analyzed data from a pragmatic, national randomized controlled trial of a comprehensive care coordination program conducted by a large national insurer and assessed its impacts on medication adherence in diabetes, atrial fibrillation, and hypothyroidism. We performed intention-to-treat (ITT) analyses (primary) and instrumental variable (IV) analyses (secondary) for HNHC beneficiaries from 2019 through 2022. Analyses compared treatment of control arms for metformin in diabetes (n = 3,602), statins in diabetes (n = 3,938), direct oral anticoagulants in atrial fibrillation (n = 326), and levothyroxine in hypothyroidism (n = 2,496). The primary adherence outcome was defined as proportion of days covered (PDC) greater than or equal to 80%, with continuous adherence measured as a secondary outcome. We used multivariate regression models to compare outcomes between arms. For the IV analyses, we used randomization status as the instrument. Covariates included age, sex, geographic location, plan type, and 18 comorbidity indicators. We also conducted…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 3,938 participants or records.
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