Impact of a text messaging pilot program on patient medication adherence.

BACKGROUND: Medication nonadherence is a well-recognized challenge associated with poor health outcomes and increased utilization of health care resources. Although many different behavioral and educational strategies are available to improve patient medication adherence, technological advances, including cell phone text messaging, represent new and innovative modalities to improve adherence and overall health outcomes. OBJECTIVE: To evaluate medication adherence among patients opting to receive text message medication reminders and a well-matched control cohort. METHODS: This retrospective, observational cohort analysis compared medication adherence of members who opted-in to the text message medication reminder program and a matched control cohort using data from a member portal database and electronic pharmacy claims of a national pharmacy benefit manager with commercial and Medicare membership. Continuously enrolled members who opted to receive at least 1 medication-specific dosage reminder for a chronic oral medication of interest and had at least 1 pharmacy claim for the same chronic oral medication of interest were included. Matching was based on medication therapeutic class, then on propensity score (including variables of age, sex, health plan, Chronic Disease Score, distinct medication count, average baseline medication adherence, and duration of therapy). The primary outcome was chronic oral medication adherence, measured as the proportion of days covered (PDC), between January 1, 2011, and August 31, 2011. Analyses comparing cohorts were conducted using paired t tests and the McNemar test. RESULTS: After implementation of the text messaging program, the mean (SD) PDC was significantly higher for the text message cohort (n = 290) than for the control cohort (n = 290) (0.85 [0.20] vs 0.77 [0.28], respectively; P < 0.001). Of those members identified with a chronic oral antidiabetes medication, the mean PDC was significantly higher in the text message cohort than in the control cohort (0.91 [0.14] vs 0.82 [0.21]; P = 0.029). Significant differences in mean PDC were also seen in members who opted to receive text message reminders for ß-blocker therapy over members in the control cohort (0.88 [0.18] vs 0.71 [0.29]; P = 0.006). CONCLUSIONS: Findings suggest that members opting into a text message reminder program have significantly higher chronic oral medication adherence compared with members not opting to receive medication-specific text message reminders, and that the use of a text message reminder program assists in preserving higher rates of adherence over time.

Mail-order pharmacy use and medication adherence among Medicare Part D beneficiaries with diabetes.

OBJECTIVE: To examine medication adherence among Medicare Part D beneficiaries initiating oral anti-diabetic medications and explore whether there is any association of using mail-order pharmacy (vs. retail pharmacy) with better adherence in this patient population. RESEARCH DESIGN AND METHODS: Using administrative pharmacy claims data, we conducted a retrospective cohort study on Medicare Part D beneficiaries who newly initiated oral anti-diabetic treatment between July 1, 2008 and December 31, 2008. Mail-order pharmacy users were matched to retail pharmacy users via propensity scoring, controlling for patient demographic and clinical characteristics. Adherence with oral anti-diabetic medications during the benefit year of 2009 was assessed using the proportion of days covered (PDC). Comparison of medication adherence between the mail-order pharmacy group and retail pharmacy group was conducted in the propensity matched sample using the paired t-tests and McNemar's tests. RESULTS: A total of 22,546 patients who initiated oral anti-diabetic medications were identified. The average PDC was 0.60 and only 41.6% of the study population attained good adherence (defined as PDC ≥ 0.8) with oral anti-diabetic medications during calendar year 2009. The matched sample included 1361 patients in each of the mail-order and retail pharmacy cohorts. Compared with the retail pharmacy group, mail-order pharmacy users demonstrated a significantly higher PDC (0.68 vs. 0.61; P < 0.001) throughout the benefit year. More patients in the mail-order pharmacy group (49.7%) attained good adherence with their oral anti-diabetic medications compared to 42.8% in the retail pharmacy group (P < 0.001). LIMITATIONS: The study was subject to limitations inherent in retrospective claims database analysis. CONCLUSIONS: Adherence with oral anti-diabetic medications among Medicare Part D beneficiaries is suboptimal. Patients using mail-order pharmacy had better adherence to oral anti-diabetic medications than those who used retail pharmacies. However, the causal relationship between mail-order pharmacy use and adherence should be further examined in a randomized study setting.

Outcomes of a rheumatoid arthritis disease therapy management program focusing on medication adherence.

BACKGROUND: A national pharmacy benefits management company implemented a rheumatoid arthritis (RA) disease therapy management (DTM) program as an enhanced offering to patients receiving specialty pharmacy services. The program was designed to improve medication adherence, maximize therapeutic outcomes, and enhance physical functioning and health-related quality of life (HRQOL) by empowering patients and improving their knowledge of RA. OBJECTIVES: To evaluate (a) adherence to injectable RA medications for patients participating in an RA DTM program compared with nonparticipating patients receiving injectable RA medications at specialty or community pharmacies and (b) HRQOL, work productivity, and physical functioning before versus after completing the RA DTM program. METHODS: Patients who had an RA diagnosis and a pharmacy claim for an injectable RA medication during the identification period (August 2007 through September 2008) and were continuously enrolled with the plan from 4 months before through 8 months after the identification date were stratified into 3 patient cohorts: DTM, specialty pharmacy, and community pharmacy. DTM patients were further categorized into a DTM intent-to-treat (ITT) cohort (all 340 DTM-enrolled patients) and a DTM completer cohort (subset of 266 ITT patients who completed the month 6 consultation). DTM completer, specialty, and community pharmacy cohorts were matched 1:1:1 (n = 244 in each cohort after matching) using a propensity score that represented the likelihood of completing the DTM program. The primary outcome was adherence to injectable RA medications, measured as the proportion of days covered (PDC) over an 8-month post-identification period. Patient-reported outcomes (short form [SF]-12, Work Productivity Activity Impairment [WPAI], and Health Assessment Questionnaire-Disability Index [HAQ-DI]) were evaluated among all 371 DTM patients who completed the month 0 and month 6 consultations regardless of whether they met continuous enrollment requirements (patient-reported sample). RESULTS: Of specialty pharmacy patients, approximately 14% chose DTM participation. During the post-identification period, mean PDC was 0.83 for DTM ITT, 0.89 for DTM completer, 0.81 for specialty pharmacy, and 0.60 for community pharmacy patients. Differences were statistically significant for both DTM cohorts compared with the community pharmacy cohort (P < 0.001) and for the DTM completer cohort compared with the specialty pharmacy cohort (P < 0.001), but not for the DTM ITT cohort compared with the specialty pharmacy cohort (P = 0.291). In the patient-reported sample, mean SF-12 physical component scores significantly increased by 1.1 points (P = 0.048); mean SF-12 mental component scores were not significantly changed (P = 0.679); mean WPAI work productivity decreased by 10.8 percentage points (P = 0.045); and mean HAQ-DI scores significantly improved by 0.08 points (P < 0.001). CONCLUSIONS: Patients participating in the RA DTM program had significantly higher injectable RA medication adherence compared with community pharmacy patients. Adherence to injectable RA medications was significantly higher for patients completing the RA DTM program, but not for the DTM ITT group, compared with patients receiving specialty pharmacy services alone. Patients completing the RA DTM program experienced improvements in SF-12 physical component and HAQ-DI scores but did not demonstrate improvements to SF-12 mental scores or work productivity.