Cohere Health, Boston, MA, USA.
University of Hawaii at Manoa, Honolulu, HI, USA.
J Gen Intern Med. 2021 Jan;36(1):154-161. doi: 10.1007/s11606-020-06237-8. Epub 2020 Oct 1.
Mail order pharmacy (MOP) use has been linked to improved medication adherence and health outcomes among patients with diabetes. However, no large-scale intervention studies have assessed the effect of encouraging MOP use on medication adherence.
To assess an intervention to encourage MOP services to increase its use and medication adherence.
Randomized encouragement trial.
63,012 diabetes patients from three health care systems: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Hawaii (KPHI), and Harvard Pilgrim Health Care (HPHC) who were poorly adherent to at least one class of cardiometabolic medications and had not used MOP in the prior 12 months.
Patients were randomized to receive either usual care (control arm) or outreach encouraging MOP use consisting of a mailed letter, secure email message, and automated telephone call outlining the potential benefits of MOP use (intervention arm). HPHC intervention patients received the letter only.
We compared the percentages of patients that began using MOP and that became adherent to cardiometabolic medication classes during a 12-month follow-up period. We also conducted a race/ethnicity-stratified analysis.
During follow-up, 10.6% of intervention patients began using MOP vs. 9.3% of controls (p < 0.01); the percent of cardiometabolic medication delivered via mail was 42.1% vs. 39.8% (p < 0.01). Metformin adherence improved in the intervention arm relative to control at the two KP sites (52% vs. 49%, p < 0.01). Stratified analyses suggested a significant positive effect of the intervention in White (RR: 1.12, 95% CI: 1.03, 1.22) and Asian (RR: 1.30, 95% CI: 1.17, 1.45) patients.
This pragmatic trial showed that simple outreach to encourage MOP modestly increased its use and improved adherence measured by refills to a key class of diabetes medications in some settings. Given its minimal cost, clinicians and health systems should consider outreach interventions to actively promote MOP use among diabetes patients.
ClinicalTrials.gov registration number: NCT02621476.
邮购药房（MOP）的使用与糖尿病患者的药物依从性和健康结果的改善有关。然而，没有大规模的干预研究评估鼓励 MOP 使用对药物依从性的影响。
评估一项鼓励 MOP 服务的干预措施，以增加其使用和药物依从性。
随机鼓励试验。
来自三个医疗保健系统的 63012 名糖尿病患者：加利福尼亚州凯撒永久北部（KPNC）、夏威夷州凯撒永久（KPHI）和哈佛朝圣者健康保健（HPHC），他们至少有一种心血管代谢药物的依从性较差，并且在过去 12 个月内没有使用 MOP。
患者被随机分配接受常规护理（对照组）或鼓励使用 MOP 的外展服务，包括邮寄信、安全电子邮件消息和自动电话，概述使用 MOP 的潜在好处（干预组）。HPHC 干预患者仅收到信。
我们比较了在 12 个月的随访期间开始使用 MOP 和对心血管代谢药物类别的依从性的患者百分比。我们还进行了种族/民族分层分析。
在随访期间，10.6%的干预患者开始使用 MOP，而对照组为 9.3%（p<0.01）；通过邮件发送的心血管代谢药物的比例为 42.1%，而对照组为 39.8%（p<0.01）。与对照组相比，在 KP 两个站点，干预组的二甲双胍依从性有所改善（52%比 49%，p<0.01）。分层分析表明，该干预措施对白人和亚洲人（RR：1.12，95%CI：1.03，1.22）患者有显著的积极影响。
这项实用试验表明，简单的外展活动鼓励 MOP 的使用略有增加，并且在某些情况下，通过补充关键类别的糖尿病药物来改善依从性。鉴于其成本低，临床医生和医疗系统应考虑积极促进糖尿病患者使用 MOP 的外展干预措施。
ClinicalTrials.gov 注册号：NCT02621476。
