Getting patients to swallow their medicine
Faxing alerts to physicians not enough to improve antidepressant adherenceBOSTON--In a study designed to assess whether alerts faxed to physicians can help to improve patient adherence to antidepressant medications, Kara Zivin Bambauer, PhD, research fellow in the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care) and colleagues have concluded that fax interventions to prescribers did not positively affect rates of patient adherence. The results are reported in the March 13 Archives of Internal Medicine.
Depression is a major source of illness, lost productivity, and health care expenditures. Antidepressants are most effective in reducing depression symptoms, relapse, and recurrence when taken in accordance with treatment guidelines. Yet many patients do not continue taking medication for the recommended minimum six-month regimen. Using real-time pharmacy information to alert physicians regarding patient non-adherence to antidepressants, Harvard Pilgrim Health Care, a non-profit health plan with more than 925,000 members, began its antidepressant compliance program in an attempt to further improve already strong patient adherence through implementation of a simple, low-cost strategy.
"Our findings confirm that patient-specific alerts using faxes to physicians are not effective at improving patient adherence to antidepressant therapy in the absence of other complementary, coordinated interventions," said Bambauer.
Bambauer and colleagues assessed the pharmacy records of more than 13,000 patients who were starting treatment with antidepressants. They found that faxed alerts to prescribers when patients stopped taking their medications earlier than recommended did not increase antidepressant adherence rates. While this particular strategy did not produce the results desired, Harvard Pilgrim continues to implement programs to increase health care quality while lowering health care costs and continues its commitment to sharing best practices with the medical community.
"Harvard Pilgrim is enthusiastic about the publication of this study, despite the lack of impact, because it will significantly increase the literature on compliance of adherence strategies and complements our push for greater transparency in all areas of health care," said Neil Minkoff, MD, a medical director for Harvard Pilgrim Health Care.
This work was funded by the Harvard Pilgrim Health Care Foundation.
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HARVARD PILGRIM HEALTH CARE
Harvard Pilgrim Health Care is a not-for-profit health care plan operating in Massachusetts, New Hampshire, and Maine with a network of more than 22,000 doctors, 135 hospitals, and more than 925,000 members. Harvard Pilgrim was the first New England health plan to establish a non-profit foundation with the sole purpose of serving the community at large. The efforts of the foundation reflect Harvard Pilgrim's mission, which is to improve the health of its members and the health of society. The Department of Ambulatory Care and Prevention is a unique partnership between HPHC and HMS, the nation's only medical school department jointly sponsored by a health plan.
HARVARD MEDICAL SCHOOL
Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, the CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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