Tele-Pharmacy Intervention to Improve Treatment Adherence

Long-term adherence to evidence-based medications remains exceptionally poor. Half of all
patients become non-adherent within a year of treatment initiation. Interventions that
improve medication adherence may have important clinical benefits across large populations,
and may even be cost-saving by reducing rates of costly and morbid clinical outcomes such as
myocardial infarction and stroke.

The Study of a Tele-pharmacy Intervention for Chronic diseases to Improve Treatment adherence
(STIC 2 IT) is a cluster randomized controlled trial (RCT) evaluating whether a novel
tele-pharmacist-based intervention improves medication adherence and disease control among
individuals with hyperlipidemia, hypertension, and diabetes who are nonadherent to their
medications and who have poor or worsening disease control. The intervention consists of a
brief telephonic consultation with a clinical pharmacist using behavioral interviewing
techniques tailored to patient's level of health activation and progress reports of
medication-taking and disease control. Based on the barriers identified during the
consultation, patients will be offered more intensive support including reminder and
motivational text-messages, video visits and pillboxes. Potentially eligible patients will be
identified using data from paid-prescription claims data and the electronic health record.
The study is being conducted at 14 practice sites in a large multi-specialty group practice
with approximately 250 primary care physicians. Practice sites will be randomized to
intervention or control. In intervention sites, the primary care physicians of potentially
eligible patients will be asked whether they would like patients to be enrolled in the
intervention.

Inclusion Criteria:

- Filled and poorly adherent (defined as a PDC < 80%) to medication for hyperlipidemia,
hypertension, or diabetes

- Suboptimal average adherence to all of the qualifying medications that a patient has
filled (defined as combined (average of averages) PDC < 80%)

- For patients with hypertension or diabetes, poor or worsening disease control
(according to relevant clinical targets)

Exclusion Criteria:

- Patients with <6 months of continuous enrolment in the health plan

- Patients with no available contact information