Susan Abughosh|Xin Wang|Omar Serna|C. Henges|Santhi Masilamani|E. James Essien|Nancy Chung|Marc L. Fleming
A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan
University of Houston|University of Houston|Cigna (United States)|Cigna (United States)|University of Houston|University of Houston|University of Houston|University of Houston
patients comorbid hypertension htn diabetes mellitus dm high risk developing macrovascular microvascular complications dm controlling high blood pressure greatly reduce complications angiotensinconverting enzyme inhibitors aceis angiotensin ii receptor blockers arbs recommended patients dm htn american diabetes association guidelines benefit efficacy reducing macrovascular microvascular complications dm well documented poor adherence however remains significant barrier achieving full effectiveness optimal outcomesto examine effect brief pharmacist telephone intervention identifying adherence barriers improving adherence aceiarb medications among nonadherent patients comorbid htn dm enrolled medicare advantage plancignahealthsprings medical claims data used identify patients htn dm diagnoses using icd9cm codes 401 250 least 2 fills aceis arbs january 2013 october 2013 patients failed refill medication 1 day proportion days covered pdc 08 considered nonadherent contacted pharmacist phone identify adherence barriers two outcome variables evaluated first adherence aceisarbs defined pdc 6 months following phone call intervention second outcome variable categorical outcome discontinuation versus continuation discontinuation defined using aceisarbs 6month postintervention period patients disenrolled plan 2014 switched another medication commonly used treating dm htn excluded analysis descriptive statistics conducted assess frequency distribution sample demographic characteristics baseline multiple linear regression conducted assess intervention effect adherence 6 months postintervention using first outcome postintervention pdc adjusting baseline pdc covariates logistic regression performed assess association medication discontinuation baseline characteristics using second outcome discontinuation control variables models included demographics age sex language physician specialty primary care vs specialist health plan lowincome subsidy vs centers medicare medicaid risk score charlson comorbidity index number distinct medicationsin total 186 hypertensive diabetic patients nonadherent aceisarbs pdc 08 included study 186 patients 87 received pharmacist phone call intervention among patients forgetfulness 2529 doctor issues difficulty scheduling appointments 1679 commonly reported barriers excluding switched aceisarbs another medication 157 patients included logistic regression model 131 continued using aceisarbs included linear regression model mean sd postintervention pdc intervention group 058 026 control group 029 017 intervention significant predictor better adherence linear regression model adjusting baseline covariates 03182 95 ci 019038 p 0001 covariates significantly associated better adherence logistic regression model discontinuation 26 yes131 predicting medication discontinuation patients received intervention likely continue using aceisarbs 356 95 ci 1061186 higher comorbidity index less likely continue using 072 95 ci 053099the brief pharmacist telephone intervention resulted significantly better pdcs 6 months following intervention well lower discontinuation rates among group nonadherent patients comorbid htn dm overall pdc rates intervention control groups still lower recommended 80 improving adherence clinically meaningful values may require brief pharmacist phone call incorporating motivational interviewing techniques followup calls address adherence barriers may influential forming sustainable behavioral change enhancing medication adherence