Improving medication adherence with a targeted, technology-driven disease management intervention

I found this abstract in NCBI: Pub Med from a BCBS of South Carolina study. The results definitely support our Adherence 2.0 model. The question is, should mail order pharmacies start sending refills if they are due? I know several pharmacies have auto-fill programs, but should there be a triggering mechanism that gets the refills out the door after a week?

I transfered a refill online at a big box retailer to check out their pharmacy services, and did not get around to picking it up for three weeks (I sent the refill early, and my wife had our second son the day after I sent the request). I went to pick it up, and the meds had been put back. They said it would be an hour wait, so I came back the next day.

I understand why they returned the meds, but there wasn't any contact to me - no one reached out. They had my email and telephone number, and I was signed up for their reminder program - but I received no notice. This not only lost the pharmacy money, but contributed to my non-adherence.

Would a community pharmacy have made a personalized call to let me know the script was sitting there? Should I have paid more for that service instead of opting for the "deal" at the big box? Should my health plan have been in the mix? These are all questions a patient has to decide for themselves, and the industry needs to think about.

From Pub Med:

Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes.

The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact.

Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems.

Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills.

The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05).

This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.