EHR-linked reminders improve heart medication adherence

Sometimes, a little reminder does a heart a world of good. Real-world patients given EHR-linked, automated reminders to refill prescriptions for statins and other heart medications had better adherence to medication and ultimately better outcomes.

Findings published in the November issue of the American Journal of Managed Care pointed to increased reminders and more information providing increasing response from patients. In the study, patients were assigned to usual care or one of two interactive voice recognition (IVR) call groups.

Regular IVR included a phone call reminding patients to refill medications, while enhanced IVR also included reminder letters, live outreach calls, feedback via the EHR to primary care providers, personalized health reports and bimonthly mailings. Calls occurred when patients required a prescription refill and as a reminder when patients were past due for refills.

William M. Vollmer, PhD, of Kaiser Permanente Northwest in Portland, Ore., and colleagues enrolled patients between 2011 and 2012, following them for a total of 9.6 months. Patients were enrolled from among those in the Kaiser Permanente EHR system for the Northwest, Hawaii and Georgia regions.

They found that contact through both the IVR and enhanced IVR programs improved statin and ACE inhibitors/ARBs significantly from usual care. Adherence to statins improved by 2.2 percent for IVR patients and 3 percent for patients in the enhanced IVR group. The enhanced IVR was significantly more successful for patients taking ACE inhibitors and ARBs: 3.7 percent more adherence was seen among these patients over usual care. IVR also improved ACE inhibitor/ARB adherence but not as significantly (1.6 percent increase).

For both statins and ACE inhibitors/ARBs, intervention improved the amount of adherence, in that more patients were more likely to achieve 80 percent adherence over the intervention period compared with patients in usual care.

In response, those with enhanced IVR taking statins had a mean drop in low-density lipoprotein (LDL) cholesterol levels by 1.5 mg/dL. The largest mean difference occurred in those whose starting LDL was above 100 mg/dL; however, there appeared to be no effect among patients whose cholesterol was already well controlled. Among patients with poor control, gains in adherence via IVR and enhanced IVR resulted in LDL reductions by 1.7 and 3.6 mg/dL, respectively, compared to usual care.

However, no significant improvements were seen in blood pressure control between usual care, IVR and enhanced IVR among patients taking ACE inhibitors/ARBs, despite improved adherence.

Vollmer et al reported that 70 percent of patients appreciated the calls and listened to at least one call completely. Action was prompted in nearly 60 percent of patients called. Nearly all patients (94 percent) contacted believed that this should have been a more widespread service.

The team noted that strategies that combined patient preference and tailored clinical support may be the future direction for interventions in this field.