Bambauer Kara Zivin, Adams Alyce S, Zhang Fang, Minkoff Neil, Grande Andrea, Weisblatt Rick, Soumerai Stephen B, Ross-Degnan Dennis
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
Arch Intern Med. 2006 Mar 13;166(5):498-504. doi: 10.1001/archinte.166.5.498.
Many managed care organizations use feedback based on electronically maintained claims data to alert physicians to potential treatment problems, including patient medication nonadherence. However, the efficacy of such interventions for improving adherence among patients treated for depression is unknown.
We examined an antidepressant compliance program consisting of faxed alerts to physicians beginning May 2003 using interrupted time series analysis to evaluate its impact on rates of antidepressant adherence between May 2002 and May 2004 among members of the managed care plan of Harvard Pilgrim Health Care, which is a health plan operating in 3 states in New England, with corporate headquarters in Wellesley, Mass. The program alerted prescribing physicians to patients with gaps of more than 10 days in refilling antidepressant prescriptions during the first 180 days of treatment. Our outcome measures were rates of nonadherence among patients with refill gaps of more than 10 days ("delayed refill") and proportion of days without treatment within the first 180 days of treatment.
A total of 13 128 patients (> or = 18 years of age) who were starting treatment with antidepressants met the study criteria. Rates of nonadherence among patients with delayed refills remained constant (P = .22) over the 2-year study period, averaging 75% (95% confidence interval, 72.7%-77.3%). Rates of antidepressant nonadherence significantly increased over time (P = .04), with an average of 40% (95% confidence interval, 38.4%-41.6%) of days without dispensed antidepressants available during treatment episodes.
Using real-time pharmacy information to alert physicians regarding patient adherence was not successful in increasing antidepressant adherence rates among members of the managed care plan. Effectiveness of electronically triggered, patient-specific, faxed feedback should be carefully evaluated before widespread implementation, because faxes are insufficient as a stand-alone policy tool.
许多管理式医疗组织利用基于电子保存的索赔数据的反馈，提醒医生注意潜在的治疗问题，包括患者用药不依从。然而，此类干预措施对改善抑郁症患者依从性的效果尚不清楚。
我们研究了一项抗抑郁药依从性计划，该计划从2003年5月开始向医生发送传真警报，采用中断时间序列分析来评估其对2002年5月至2004年5月期间哈佛朝圣者医疗保健管理式医疗计划成员中抗抑郁药依从率的影响。该计划是一家在新英格兰三个州运营的健康计划，公司总部位于马萨诸塞州韦尔斯利。该计划提醒开处方的医生注意在治疗的前180天内抗抑郁药处方 refill 间隔超过10天的患者。我们的结局指标是 refill 间隔超过10天（“延迟 refill”）的患者的不依从率，以及治疗前180天内无治疗天数的比例。
共有13128名开始使用抗抑郁药治疗的患者（≥18岁）符合研究标准。在为期2年的研究期间，延迟 refill 患者的不依从率保持不变（P = 0.22），平均为75%（95%置信区间，72.7%-77.3%）。抗抑郁药不依从率随时间显著增加（P = 0.04），治疗期间平均有40%（95%置信区间，38.4%-41.6%）的天数没有可分发的抗抑郁药。
利用实时药房信息提醒医生注意患者依从性，未能成功提高管理式医疗计划成员的抗抑郁药依从率。在广泛实施之前，应仔细评估电子触发的、针对患者的传真反馈的有效性，因为传真作为一种单独的政策工具是不够的。
