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Technology-based tools, EMRs improved CVD medication adherence
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Leveraging technology-based tools in conjunction with electronic medical records improved chronic disease medication adherence and cardiovascular disease risk factors, according to research published in The American Journal of Managed Care.
In the Promoting Adherence to Improve Effectiveness of Cardiovascular Disease Therapies (PATIENT) trial, William M. Vollmer, PhD, of Kaiser Permanente Northwest in Portland, Ore., and colleagues evaluated two electronic medical record (EMR)-linked, automated phone reminder interventions for adults with diabetes or atherosclerotic CVD.
William M. Vollmer
“The PATIENT trial demonstrated that a low-cost EMR-based intervention, utilizing health information technology tools, can improve adherence among patients with diabetes and/or CVD as part of a population-based disease management strategy,” the researchers wrote.
For the parallel-arm, pragmatic clinical trial, the researchers studied 21,752 suboptimally adherent patients aged at least 40 years for 1 year at three large health maintenance organizations. Patients were randomly assigned to usual care, a regular interactive voice recognition call (IVR) or an enhanced interactive voice recognition call (IVR+).
With IVR, patients received automated phone calls when they were due or overdue for a refill. With IVR+, patients received the calls, plus personalized reminder letters, live outreach calls, EMR-based feedback to their primary care providers and additional mailed materials.
The researchers primarily looked at medication adherence but also gauged blood pressure and lipid levels.
Adherence to statins and angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers increased with both interventions compared with usual care. Patients demonstrated higher adherence to ACE inhibitors/angiotensin receptor blockers with IVR+ vs. IVR. The differences remained across subgroups.
“Although the improvements were statistically significant across subgroups, the overall effect was small (1.6-3.7 percentage points),” the researchers wrote.
Patients receiving statins showed reduced LDL levels at follow-up with IVR+ vs. usual care (change, –1.5 mg/dL; 95% CI, –2.7 to –0.2). The effect was observed mainly in patients with baseline LDL levels >100 mg/dL (change, –3.6 mg/dL; 95% CI, –5.9 to –1.3).
“Future interventions that combine [health information technology]-based systems, perhaps with strategies customized to patient preference and more tailored clinical support, offer a promising next step,” the researchers wrote.
Disclosure: This project was supported by a grant from the Agency for Healthcare Research and Quality.
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