Encouraging Mail Order Pharmacy Use to Improve Outcomes and Reduce Disparities
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 6/8/2018 |
| Start Date: | February 1, 2017 |
| End Date: | May 2019 |
The investigators propose a randomized encouragement trial to encourage use of the existing
mail order pharmacy services among diabetes patients with poor adherence to CVD risk factor
medications in 3 health care systems: Kaiser Permanente Northern California, Harvard Pilgrim,
and Kaiser Permanente Hawaii.
mail order pharmacy services among diabetes patients with poor adherence to CVD risk factor
medications in 3 health care systems: Kaiser Permanente Northern California, Harvard Pilgrim,
and Kaiser Permanente Hawaii.
Adherence to effective cardiovascular disease (CVD) risk factor medications is associated
with improved CVD risk factor control, fewer hospitalizations, and lower mortality in
patients with diabetes. However, many patients are poorly adherent to medications, and there
are persistent racial/ethnic and socioeconomic disparities in medication adherence.
Traditional clinical trials of interventions to improve medication adherence are often
resource-intensive, and focus exclusively on patient-level barriers to behavior change.
Unsurprisingly, these trials have not led to sustainable, cost-effective approaches to
improve adherence. Health system-level medication adherence interventions that can be
implemented, "scaled up," and sustained across a wide range of health care delivery settings
are urgently needed. The investigators propose a randomized encouragement trial to encourage
use of existing mail order pharmacy services among diabetes patients with poor adherence to
CVD risk factor medications and who only use retail pharmacies in 3 health care systems:
Kaiser Permanente Northern California, Harvard Pilgrim, and Kaiser Permanente Hawaii. These
combined systems include approximately 300,000 patients with diabetes with diverse
racial/ethnic and socioeconomic backgrounds. Patients with no history of mail order pharmacy
use will be randomized into 2 arms. In addition to examining the impact of the intervention
on medication adherence and CVD risk factor control, the investigators will examine factors
affecting the sustainability and dissemination of the intervention, assess the intervention's
impact on utilization and health care costs, and determine whether the intervention's impact
differs across racial/ethnic and socioeconomic subgroups. This research will provide a
foundation for developing sustainable, system-level approaches to addressing medication
adherence in diabetes patients that can be widely disseminated and implemented across a
diverse array of health care systems.
with improved CVD risk factor control, fewer hospitalizations, and lower mortality in
patients with diabetes. However, many patients are poorly adherent to medications, and there
are persistent racial/ethnic and socioeconomic disparities in medication adherence.
Traditional clinical trials of interventions to improve medication adherence are often
resource-intensive, and focus exclusively on patient-level barriers to behavior change.
Unsurprisingly, these trials have not led to sustainable, cost-effective approaches to
improve adherence. Health system-level medication adherence interventions that can be
implemented, "scaled up," and sustained across a wide range of health care delivery settings
are urgently needed. The investigators propose a randomized encouragement trial to encourage
use of existing mail order pharmacy services among diabetes patients with poor adherence to
CVD risk factor medications and who only use retail pharmacies in 3 health care systems:
Kaiser Permanente Northern California, Harvard Pilgrim, and Kaiser Permanente Hawaii. These
combined systems include approximately 300,000 patients with diabetes with diverse
racial/ethnic and socioeconomic backgrounds. Patients with no history of mail order pharmacy
use will be randomized into 2 arms. In addition to examining the impact of the intervention
on medication adherence and CVD risk factor control, the investigators will examine factors
affecting the sustainability and dissemination of the intervention, assess the intervention's
impact on utilization and health care costs, and determine whether the intervention's impact
differs across racial/ethnic and socioeconomic subgroups. This research will provide a
foundation for developing sustainable, system-level approaches to addressing medication
adherence in diabetes patients that can be widely disseminated and implemented across a
diverse array of health care systems.
Inclusion Criteria:
- Diabetes patients who are users of CVD risk factor medications (antihypertensive
therapies, antihyperlipidemics therapies, and oral antihyperglycemic therapies),
- Diabetes patients considered to be poorly adherent to CVD risk factor medications
within the prior 12 months
- Diabetes patients who have not used the mail order pharmacy to fill any prescribed
medications at least once in the prior 12 months
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