Specialty Clinical Innovation and Product Development, CVS Health, Lincoln, Rhode Island.
Specialty Clinical Innovation and Program Development, CVS Health, Lincoln, Rhode Island.
J Manag Care Spec Pharm. 2019 Nov;25(11):1290-1296. doi: 10.18553/jmcp.2019.25.11.1290.
Adherence to treatment is correlated with treatment success in chronic myeloid leukemia (CML). CVS Specialty explored novel methods to improve adherence in this population to ensure optimal adherence and lower the risk of unsuccessful treatment. One novel program explored involved an interactive 2-way clinical messaging technology that coaches patients with adherence and knowledge about taking their treatment and managing their conditions. Clinical secure messaging is a 2-way messaging program distinct from the 1-way refill reminders and order status messages that patients were receiving if opted into the messaging program.
To assess the effect on adherence of 2-way clinical messaging in a CML population treated with tyrosine kinase inhibitors (TKIs) compared with patients enrolled in 1-way refill reminders.
A retrospective cohort study was conducted using prescription claims data. Patients new to TKI therapy and enrolled in at least 1-way messaging were identified and divided into control and study cohorts based on clinical messaging enrollment status. Participants were followed for 365 days after their first fill. Adherence outcomes were defined by medication possession ratio (MPR), length of therapy, first fill drop-off rate, and gap days between refills. Optimal adherence was defined as an MPR ≥ 85%.
Patients receiving clinical messaging had on average a 7.64% higher MPR score (MPR: 73.94% vs. 66.30%) compared with the control arm ( = 0.0063). This translates to 22% more patients being optimally adherent while exposed to clinical messaging ( = 0.022). Patients in the exposed group had a mean 32-day increase in average length of therapy compared with the control group (243 days vs. 275 days, = 0.0043), potentially driving an increase in adherence. Additional drivers included a 5.4 percentage point reduction in first fill drop-off rates (4.66% vs. 10.04%, = 0.0149). Persistency after 12 months was similar between the study arms (41%).
Two-way clinical messaging positively affected adherence outcomes in a CML population. This effect was in addition to 1-way refill reminders and order status messages. The nature of the clinical content encourages further investigation into this novel execution of adherence coaching and counseling through a digital platform.
Funding for this research was provided by CVS Health. The sponsor was involved at all stages of the study's conduct and reporting. Sawicki and Friend are employed by CVS Health. The other authors were employed by CVS at the time of this study. The authors have nothing more to disclose. Posters based on this work were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, CA, and AMCP Nexus 2016; October 3-6, 2016; National Harbor, MD.
在慢性髓性白血病（CML）中，治疗的依从性与治疗的成功相关。CVS Specialty 探索了新的方法来提高该人群的治疗依从性，以确保最佳的依从性并降低治疗失败的风险。一项新的研究涉及到一种互动的双向临床信息传递技术，该技术可以指导患者提高依从性和了解如何服用治疗药物以及管理病情。临床安全信息传递是一种双向信息传递程序，与患者选择加入信息传递程序后收到的单向补充提醒和订单状态消息不同。
评估与接受单向补充提醒的 CML 患者相比，接受酪氨酸激酶抑制剂（TKI）治疗的患者使用双向临床信息传递对依从性的影响。
使用处方索赔数据进行回顾性队列研究。确定了新接受 TKI 治疗且至少参加过一次单向信息传递的患者，并根据临床信息传递登记状况将其分为对照组和研究组。参与者在首次配药后 365 天内进行随访。通过药物利用率（MPR）、治疗时间长度、首次配药脱落率和补充之间的空白天数来定义依从性结果。最佳依从性定义为 MPR≥85%。
与对照组相比，接受临床信息传递的患者的 MPR 评分平均高出 7.64%（MPR：73.94% vs. 66.30%， = 0.0063）。这意味着接受临床信息传递的患者中有 22%的患者能够更加依从治疗（ = 0.022）。与对照组相比，暴露组患者的平均治疗时间长度增加了 32 天（243 天 vs. 275 天， = 0.0043），这可能会提高患者的依从性。其他驱动因素包括首次配药脱落率降低了 5.4 个百分点（4.66% vs. 10.04%， = 0.0149）。研究组在 12 个月后的持续性相似（41%）。
双向临床信息传递对 CML 患者的依从性结果产生了积极影响。这种影响除了单向补充提醒和订单状态消息外，还存在其他影响。这种临床信息传递的性质鼓励进一步通过数字平台探索这种新型的依从性指导和咨询的执行。
本研究的资金由 CVS Health 提供。赞助商参与了研究的所有阶段和报告。Sawicki 和 Friend 受雇于 CVS Health。其他作者在进行这项研究时受雇于 CVS。作者没有其他要披露的信息。基于这项工作的海报曾在 2016 年 AMCP 管理式医疗和专科药房年会、2016 年 4 月 19-22 日旧金山和 2016 年 AMCP Nexus 会议、2016 年 10 月 3-6 日马里兰州国家港展出。
