According to a World Health Organization report, more than half of patients do not take their medicines properly, resulting in poor health outcomes and avoidable healthcare expenditures. Another report puts the estimated losses to the pharmaceutical industry due to medication non-adherence in the US alone at $290 billion.
Poor drug compliance is particularly prevalent in chronic disease management.
While many interventions have been designed to improve medication compliance rates, most of them are often complex and costly.
Successful interventions that are effective in long-term chronic care typically consist of multiple components such as personalized care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and more supportive care.
In recent times, researchers have been experimenting with less expensive digital health technology-based intervention.
These include automated calls, texts and mailings to boost medication compliance rates - but most such studies involved only select patient populations; and hence generalizing those results to wider populations is questionable.
Now, a large scale study, which included 21,752 Kaiser Permanente patients suffering from diabetes and cardiovascular problems, found that by using Electronic Medical Record-linked automated phone reminder interventions, medication adherence levels can be increased.
Study results were published in the American Journal of Managed Care, and concluded that regular and enhanced interactive voice recognition reminder calls improved adherence to cardiovascular disease medications by 2 percentage points.
While this might seem like a small improvement, authors say that such small improvements can make a big difference in large populations.
For example, a 2 mm Hg change in blood pressure, on a population basis, can translate into a change in long-term cardiovascular risk.
“This small jump might not mean a lot to an individual patient, but on a population level it could translate into fewer heart attacks, fewer deaths and fewer hospitalizations, which will ultimately have an important impact on public health,” said Bill Vollmer, PhD, lead author and senior investigator at the Kaiser Permanente Center for Health Research, in Portland.
The year-long study examined the effectiveness of Kaiser Permanente’s PROMPT medication reminder program which had three arms: usual care, automated telephone call intervention and an enhanced intervention consisting of reminder letters, personalized health reports, educational mailings, automated calls and live calls for those who did not respond to the automated calls.
Along with 1.6 to 3.7 percentage points of improvement in medication adherence levels, the intervention also led to significant reductions in cholesterol levels of the patients. The increase was prominent in the subset of people who started out with baseline LDL-cholesterol levels of above 100 mg/dl, which is considered uncontrolled, but showed a 3.6 mg/dl greater reduction in cholesterol than the control group.
Assuming a sustained effect, this 3.6 mg/dl reduction could translate into a nearly 1% reduction in mortality and 2% reduction in major vascular events in large populations, thereby having a very meaningful public health impact.
It’s the large, real-world patient population and randomized design nature of the study that makes it important in validating the notion that with the use of low-cost, EMR-based, digital health interventions, it is possible to achieve significant health outcomes in population-based disease management practices.
Shiva Gopal Reddy has a Bachelor's degree in Physics and a Master's in Applied Psychology and writes frequently on the latest research, impact, happenings and trends in digital health technology.