Pharmacy Benefits Glossary
A guide to general pharmacy benefits terminology.
Gap in Care
A gap in care refers to a lapse or deficiency in the delivery of healthcare services, resulting in a disruption or interruption in a patient’s treatment or preventive care, particularly concerning chronic conditions such as diabetes, cardiovascular diseases, and more. It signifies a failure to meet recommended standards of care, which can lead to suboptimal health outcomes and increased healthcare costs.
What are Examples of Gaps in Care?
For instance, consider a patient with diabetes who is due for an annual foot exam according to clinical guidelines but misses the appointment due to scheduling conflicts or lack of awareness. This missed
What Are the Causes of Gaps in Care?
Gaps in care may occur because of multiple contributing factors, but they most often result from issues with patients, within the healthcare system, or with providers.
Patients
- Socioeconomic status: Patients who face financial constraints may lack sufficient health coverage or access to transportation or face similar obstacles that cause delayed or missed appointments and trouble acquiring recommended medications or treatments.
- Health literacy: Patients with low health literacy often struggle to understand medication labels, care instructions, or management regimens.
- Lack of adherence to treatment regimens: Failing to adhere to treatment regimens can result in exacerbated health conditions, skipped doses, and lifestyle decisions that compromise a patient’s health.
preventive screening represents a gap in care, as it can result in delayed detection of foot complications such as neuropathy or ulcers, which, if left untreated, may progress to more severe conditions requiring intensive interventions, such as amputation.
How do you Address Gaps in Care?
To address gaps in care effectively, healthcare organizations and pharmacy benefit managers (PBMs) employ various strategies, including, but not limited to:
- Implementing reminder systems
- Conducting outreach and education initiatives
- Offering care management programs
- Leveraging technology to facilitate access to needed healthcare services
Additionally, addressing social determinants of health, improving healthcare access and affordability, promoting patient engagement, and fostering collaboration among healthcare stakeholders are crucial in addressing the underlying factors contributing to health gaps and ensuring comprehensive and patient-centered care delivery.
By closing gaps in care, healthcare organizations and PBMs can improve patient outcomes, enhance population health, and optimize the utilization of healthcare resources.
