Results Mixed for PCMH Diabetes Care

Results of a new study suggest that patient-centered medical homes (PCMHs) have diverse effects on different outcomes for diabetes care.

In a study conducted to examine the association between PCMHs and process measures of diabetes care in as well as adherence to oral hypoglycemic agents (OHAs) in patients with diabetes, JaeJin An, BPharm, PhD, Western University of Health Scienwces College of Pharmacy, Pomona, CA, found that PCMHs improved process measures of diabetes but were not associated with increased adherence to OHAs.

The study included 3334 patients with diabetes identified through the 2009 to 2013 longitudinal data files from the Medical Expenditure Panel Survey. Of these patients, 378 (11.4%) met criteria at baseline for receiving usual sources of care from a PCMH. 

To assess the impact of PCMHs on diabetes care, Dr An compared process measure of diabetes care (>2 hemoglobin A1c tests and >1 cholesterol test, foot exam, dilated eye exam, and flu vaccination during 1 year of follow up) between the patients in the PCMH group and those without PCMH features.

The study found that at a higher proportion of patients in the PCMH group met process measure criteria compared with the non-PCMH group (33.8% vs 26.0%, respectively, P = .015), and an overall improvement in the process measures of diabetes care.

Patients who stayed in the PCMH for 2 years (3.6%) had an even greater improvement in process measures of diabetes care.

The study also assessed the impact of PCMHs on medication adherence to OHAs based on the medication possession ratio (MPR) during follow up. This was calculated for patients with OHAs without insulin use. Patients with an MPR lower than 80% were considered to be adherent to OHAs. 

The study found no association between PCMHs and adherence to OHAs, with a lack of statistical significance between the PCMH group and non-PCMH group in the weighted mean MPR (P = .675). Overall, this resulted in a 47.4% adherence rate among patients in the PCMH group. This lack of significant difference in adherence to OHAs remained at 2 years.

These mixed results suggest the need to better understand the effect of the PCMH model on various outcomes measures. “Future studies should further explore the effect of PCMHs on various outcomes to understand these mixed findings and to suggest changes in the health care system to improve patient adherence,” states Dr An in the conclusion of the study. —Mary Beth Nierengarten