Automated calls, letters boost med adherence

But even with reminders, compliance rate remains low
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Automated phone calls and letters to patients who did not fill prescriptions increased their rate of compliance, according to a study published in the Archives of Internal Medicine. But an accompanying commentary points out that the overall improvement was only marginal.

The researchers, from Kaiser Permanente Southern California, selected 2,606 patients to undergo the intervention and 2,610 for a control group who got no reminders. Patients were randomly assigned to the groups from a larger population of patients prescribed cholesterol-lowering statins who did not fill their prescriptions within two weeks.

The intervention group got an automated phone call, then a week later, a letter reiterating the importance to taking the medication. Cost of the two prompts was estimated at $1.70 per participant. After the reminders, 42.3 percent of the intervention group filled the prescription, compared with 26 percent of the control group.

But when it came time for refills, the percentage doing so was practically identical: 35.1 percent in the intervention group versus 35.5 percent among controls.

The researchers still called the approach a success.

"Given the prevalence of the problem, especially among patients with chronic conditions, minor improvements in medication adherence among groups of people should yield significantly better health outcomes for patients and savings for hospitals and health systems," lead researcher Stephen F. Derose, MD, of the Kaiser Permanente Southern California Department of Research & Evaluation said in an announcement.

But in an accompanying commentary, Michael A. Fischer, M.D., of Brigham and Women's Hospital in Boston, pointed out that despite the improvement of 16 percentage points in compliance, 58 percent of the intervention group still didn't fill their prescriptions. That calls for more interventions, including better understanding patients' reluctance to fill the prescriptions initially, he wrote.

Research from the Agency for Healthcare Research and Quality (AHRQ) listed reminders, as well as case management, education and collaborative care among the interventions that could be effective in improving short-term medication compliance among patients. The AHRQ report acknowledged, though, that industry still has no "silver bullet" for long-term compliance, a costly issue for the healthcare system.

One recent study estimated that accountable care organization with 10,000 Medicare beneficiaries might be able to save up to $1.1 million annually in emergency department and hospital costs by improving adherence among its patients with diabetes. It estimated that compliance among diabetic patients could save an estimated $8.3 billion overall in annual healthcare costs .

To learn more:
- here's the abstract 
- see the announcement 
- read the commentary

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