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Medication adherence: a moving target?
  1. Robin Mathews
  1. Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Robin Mathews, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27708-0187, USA; robin.mathews{at}duke.edu

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The landscape of healthcare delivery is constantly evolving in an ongoing attempt to provide effective and high-quality care. The Institute of Medicine defines quality as, ‘The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.'1 Process metrics are routinely used to assess adherence to guideline-based recommendations in patients admitted with acute coronary syndrome (ACS).2 Though we see near-ubiquitous use of evidence-based treatments among hospitalised patients, outpatient adherence to these prescribed therapies is poor. As medication non-adherence has been associated with worse outcomes and higher costs,3 it has become an area of particular interest to policy-makers. The article by Gonzalez et al, published in Heart,4 attempts to examine this timely and important topic.

The authors use a governmental policy change as a natural experiment to assess in pre–post fashion the impact of medication cost sharing on patient adherence to common secondary prevention cardiac therapies after hospital discharge for ACS. In this observational analysis of 10 563 patients discharged from 2009 to 2011 in the Valencia Health System, the authors measured prescription fill rates to assess adherence before and after a 2012 policy change by the regional government where pensioners were expected to cover 10% of medication cost (compared with none historically), and middle-to-high-income individuals saw an increase in out-of-pocket medication cost from 40% to either 50% or 60%. The authors found that adherence worsened when cost …

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