Impact of Disease Management on Utilization and Adherence With Drugs and Tests

Abstract

OBJECTIVE -The purpose of this study was to evaluate the effect of telephonic care management within a diabetes disease management program on adherence to treatment with hypoglycemic agents, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and recommended laboratory tests in a Medicaid population.RESEARCH DESIGN AND METHODS -A total of 2,598 patients with diabetes enrolled for at least 2 years in Florida: A Healthy State (FAHS), a large Medicaid disease management program, who received individualized telephonic care management were selected if they were eligible for at least 12 months before and 12 months after beginning care management. Patients were matched one-to-one on all baseline characteristics to 2,598 control patients. The impact of care management on utilization and adherence rates for diabetes-related medications and tests was analyzed with the difference-in-difference estimator.RESULTS -Changes in utilization were evaluated separately for those who were characterized as adherent to treatment at baseline ("users") and those who were not ("nonusers"). Both groups achieved significant improvement in adherence between baseline and follow-up. Nonusers increased their overall hypoglycemic use by 0.7 script (P Ͻ 0.001), by 0.7 script for ACEIs and statins (both P Ͻ 0.001), by 0.8 test for A1C (P Ͻ 0.001), and by 0.7 test for lipids (P Ͻ 0.001). Users increased hypoglycemic use by 1.5 scripts (P Ͻ 0.001) and insulin use by 0.9 script (P Ͻ 0.001).CONCLUSIONS -The FAHS telephonic care management intervention effectively induced Medicaid patients with diabetes to begin treatment and improved adherence to oral hypoglycemic agents and recommended tests. It also substantially improved adherence among baseline insulin users.

Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies

“…Of those that did, half indicated that statins were prescribed for secondary CVD prevention [ 20 – 22 , 25 , 33 , 44 – 46 , 48 ]. Other indications included primary hypercholesterolemia [ 35 ], diabetes [ 28 , 32 ] and elevated CVD risk [ 36 , 37 , 39 , 51 ]. Five studies selected patients based on poor adherence to statin therapy [ 24 , 26 , 31 , 36 , 38 ].…”

“…: 47 vs. 15 % ( p < 0.001) Proportion receiving new statin prescriptions by 4 mo. : 55 vs. 20 % ( p < 0.001) Mean change in LDL-C (mg/dL): −12.4 vs. 6.3 ( p = 0.059) [ 25 ] Peng et al (2014) Cluster RCT 47 hospitals randomized to intervention or control group Secondary CVD prevention (China) Int: 1795 Con: 2026 61.5 ± 11.5 60.4 ± 11.7 33 31 12 1E (unique password-protected website) Proportion of adherent patients (not defined): 56 vs. 33 % ( p = 0.006) NA NA [ 26 ] Pringle et al (2014) Patients were own controls Non-adherent to statins (USA) Int: 29,042 Con: 30,454 59 60 57 55 12 2A(M) Mean PDC: 0.66 (before int) vs. 0.73 (after int) ( p < 0.001) Change from baseline in proportion with PDC ≥0.80: 7 vs. 2 % ( p < 0.001) NA NA [ 27 ] Taitel et al (2012) Retrospective; Unmatched controls; Statistical analysis adjusted for co-variates Statin naïve (USA) Int: 586 Con: 516 54.2 ± 12.4 56.0 ± 12.2 54 51 12 2A(M) Mean MPR: 0.62 vs. 0.57 ( p < 0.01) Proportion with MPR ≥0.80: 40.9 vs. 33.7 % ( p < 0.01) Proportion persistent (<60 consecutive days without any statin medication available): 43.9 vs. 38.2 % ( p = 0.05) NA [ 28 ] Thiebaud et al (2008) Prospective; Matched controls Diabetes (USA) Int...…”

“…There were 17 intervention arms across 10 RCTs (or similar), 4 prospective studies and 2 retrospective studies that reported data on adherence to statins using similar, clinically meaningful measures (e.g. mean MPC or PDC) (Table 1 ) [ 22 , 23 , 26 – 28 , 30 , 32 , 35 , 41 – 45 , 48 – 50 ]. Significantly increased mean adherence to statins relative to the control group was achieved in three of the seven studies that used only one intervention type: two used multiple, face-to-face motivational interviews [+5 and +7 % points (both behavioural counselling)] [ 26 , 27 ] and one provided genotyping information for the KIF6 gene variant [+9 % points (cognitive education)] [ 23 ] (Fig.…”

Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups

“…Improvements in adherence have been shown to result from several types of interventions including policy interventions, telephonic and text message follow‐up, as well as educational interventions by pharmacists . The effect size and sustainability of these impacts on adherence and subsequent patient outcomes, however, have been somewhat modest.…”

Advances in Motivational Interviewing for Pediatric Obesity

“…Increasingly, disease management (DM) programs are being conducted telephonically 115–120 . Telephone DM counseling has been used to address a wide range of health issues including medication adherence 121,122 , diabetes control 123–127 , heart failure 120,122,128 , smoking cessation 129 , and adult weight management 130–136 . Many health care delivery systems including the Veterans Administration 126,131,137 , integrative health care delivery systems 129,138,139 , and both Medicare and Medicaid 121–124,140 use DM to manage chronic disease, and this approach appears to be increasingly utilized across the health care delivery system 139,140 .…”