Another seemingly worthwhile intervention to improve care bites the dust, according to a study in the journal Health Services Research. (HSR Article) Getting patients to comply with prescribed drug regimens is obviously important. A doctor wouldn’t order the medication if he didn’t think it would benefit the patient, and it won’t benefit the patient if they don’t take it as ordered. Other research has suggested that medication adherence failures cause significant additional medical spending and result in unnecessary hospitalizations and even deaths. So a lot of work has gone into methods of improving adherence. Physicians could be a powerful source of adherence encouragement, but may have information and time deficits. In this study, doctors were given information on their patients’ adherence to medications the doctors had prescribed and had the assistance of a pharmacist available for counseling of patients. A large provider group and a pharmacy benefit manager were used for testing the intervention, which consisted of email notifications to doctors and pharmacist counseling for the patients. The pharmacists asked about reasons for non-adherence and gave information on the importance of taking the medications. This counseling was done by phone and the patient’s physician was provided a written summary of the session after it had concluded. About 90 doctors participated in the study. About 1475 patients who had high blood pressure, high lipid levels or diabetes were the subjects for the research.
The study was divided into three arms: doctors who got only an email notification of non-adherence, physicians who got the notice and had to request pharmacist counseling for the patient, and doctors who got the notice and the pharmacist did counseling unless it was cancelled by the doctor. There was also a control group in which the doctor got no notice of non-adherence and there was no pharmacist counseling. There were about 3374 events of apparent non-adherence during the study period. Physicians were equally likely in all arms to view information about non-adherence after getting email alerts. But 37% of doctors never looked to see details of non-adherence and overall physicians only looked at the details for 33% of events for which they received notice. Pretty pathetic on the doctors part. Patients of doctors who had to request a pharmacist counseling session were 42 percentage points less likely to receive one than if the counseling session occurred automatically. But it didn’t seem to matter, there were similar patterns of ongoing non-adherence whether or not a pharmacist counseling session occurred. So while making counseling the default resulted in more counseling, it didn’t result in faster resolution of non-adherence issues. Disappointing, but just further evidence that changing behavior is not easy.