Division of Health Care Policy and Research, Department of Health Sciences Research & Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Prime Therapeutics LLC, Eagan, MN, United States.
Healthc (Amst). 2016 Sep;4(3):207-16. doi: 10.1016/j.hjdsi.2016.02.004. Epub 2016 Feb 20.
The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence.
Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members. Nonadherence was defined by the Star ratings definition of proportion of days covered (PDC)<80%. The PBM sent letters to prescribing physicians of nonadherent members, requesting that they discuss adherence barriers and potential solutions with their patients. A historical control cohort was constructed from the PBM satisfying the same eligibility criteria as the intervention cohort. Both binary (≥80%) and continuous PDC measures were assessed as outcomes through multivariate logistic regression and difference-in-difference models, respectively.
Final sample sizes were 21,044; 106,829; and 73,560 patients for antidiabetic, statin, and RAS antagonist use, respectively, with approximately equal number of intervention and control subjects in each drug class. Physician mailing was associated with 11%, 16%, and 7% higher odds of being adherent by members in antidiabetic, statin, and RAS antagonist cohorts, respectively (all P<.001).
Within limitations of historical controls, physician mailing was associated with improved medication adherence.
Physician mailing can be an impactful tool for improving medication adherence.
II.
医疗保险 5 星评级系统通过基于质量的支付计划来衡量和激励改善医疗保险部分 D 计划。慢性病药物治疗的依从性是星级评分的关键。我们的目的是评估直接向提供者发送信函对提高药物依从性的影响。
从一家大型美国药品福利管理公司（PBM）的处方索赔数据中确定了>600,000 名连续参保的医疗保险会员中不符合口服糖尿病（降糖药）、胆固醇降低（他汀类药物）或高血压（肾素血管紧张素系统[RAS]拮抗剂）药物治疗处方的成员。不依从性是根据星级评分的比例天数覆盖（PDC）<80%的定义来确定的。PBM 向未遵守规定的成员的开处方医生发送信件，要求他们与患者讨论依从性障碍和潜在解决方案。通过多元逻辑回归和差异模型分别评估了二元（≥80%）和连续 PDC 措施作为结果。
最终样本量分别为使用降糖药、他汀类药物和 RAS 拮抗剂的患者 21,044、106,829 和 73,560 例，每种药物类别的干预组和对照组的数量大致相等。在降糖药、他汀类药物和 RAS 拮抗剂队列中，医生邮寄与成员的依从性提高了 11%、16%和 7%有关（均 P<.001）。
在历史对照的限制范围内，医生邮寄与改善药物依从性有关。
医生邮寄可以成为提高药物依从性的有效工具。
II 级。
