Phone, letter prompts improve statin uptake

Telephoning and writing to individuals who have not filled their new prescription for statin medication significantly improves rates of prescription uptake, show US study results.

The findings indicate that an automated reminding system could help reduce the numbers of patients with nonadherence to newly prescribed medicines and "better target those who remain nonadherent with complementary, more resource-intensive programs," say Stephen Derose (Kaiser Permanente Southern California, Pasadena) and co-researchers.

The team compared statin dispensation rates among 2606 individuals aged an average of 56 years who were randomly assigned to receive the intervention, and 2610 individuals of the same age who received usual care (controls).

All participants were prescribed 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors for dyslipidemia, and 91% were recipients of a pharmacy drug benefit.

The intervention comprised an automated telephone call made 1-2 weeks after the prescription date, containing educational information and an encouraging personalized prompt to adhere to their statin treatment. One week after the call, if the prescription still had not been filled, a letter containing the same message was sent.

Overall, the proportion of participants who filled their statin prescription within 25 days from randomization (the day of the telephone call) and/or up to 2 weeks after expected delivery of the letter, was significantly higher among those in the intervention group compared with controls, at 42.3% versus 26.0%.

This translated to a 1.63-fold higher likelihood for adherence with the intervention than without, report Derose et al.

Logistic regression showed that Spanish speakers were a significant 1.32 times more likely than English speakers to have a statin dispensed, and having a pharmacy drug benefit increased the likelihood of filling statin prescription 10-fold.

In an accompanying editorial, Michael Fischer (Brigham and Women's Hospital, Boston, Massachusetts) remarked that while the findings may not be instantly ready for implementation, "there is promise that they will be of increasing relevance in the coming years."

He added: "Recent innovations in health care, such as patient-centered medical homes and accountable care organizations, strive to increase the integration of care, especially in the outpatient setting."

Fischer notes that although encouraging, the findings of Derose and colleagues highlight that medication nonadherence remains a "difficult problem to solve."

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