Effectiveness of mailed letters to improve medication adherence among Medicare Advantage Plan participants with chronic conditions

Abstract

BackgroundMedication adherence is associated with improved health outcomes in multiple chronic diseases. Information is needed on the effectiveness of specific adherence interventions. This study’s objectives were to quantify effects of a targeted mailing intervention on adherence among older adults at risk for nonadherence, and to examine associations of individual and plan characteristics with adherence.Materials and methodsAmong adults enrolled in a Medicare Advantage Plan with prescription drug coverage from May 2014 to June 2015, those identified as eligible for the mailing intervention had a late refill for oral antidiabetic medication, statin, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker medication and were previously unreachable by telephone. Pharmacy claims data were analyzed with the outcome of 6-month proportion of days covered (PDC) before and after the mailing. The t-test and chi-square analyses were used to evaluate univariate associations. Multivariable linear and logistic regression models were conducted to assess relative covariate effects. A sub-analysis of those with at least one medication fill post-mailing was also performed.ResultsA total of 460 non-adherent individuals aged 70±10.5 years, with 50.2% female and 66.7% white individuals, were included. Of those who were mailed a letter, 24.1% became adherent to the specified maintenance medication. Those who received >30-day supplies were more than twice as likely to become adherent after the mailed letter than those who received 30-day supplies or less (P<0.05). Baseline higher PDC was also associated with greater adherence post-mailing (P<0.01). A total of 284 (61.7%) individuals filled their medication at least once after the mailed letter; of those, 39.1% became adherent (mean [SD] change in PDC =0.15 [±0.28]).ConclusionOur findings suggest that a single mailed letter improved medication adherence by 24.1% in adults with chronic conditions. As a health plan seeking to improve its customers’ well-being and outcomes, Cigna continues to utilize targeted mail interventions to improve medication adherence.

<p>Long-Term Benefit and Withdrawal Effect of Statins After Percutaneous Coronary Intervention: A Nationwide Population-Based Cohort Study</p>

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Hepatic Encephalopathy-Related Hospitalizations in Cirrhosis: Transition of Care and Closing the Revolving Door

“…A pilot study ( N = 39) showed that HE-related hospitalizations were significantly reduced in patients receiving brief (≤ 15 min), targeted outpatient education (i.e., focused on the pathophysiology of HE, maintenance of bowel movements, treatment of HE) facilitated by nurses compared with patients not receiving this intervention (HR, 0.14; 95% CI, 0.02–0.77; P = 0.02) [ 65 ]. Another study showed that almost one-quarter (24.1%) of patients ( N = 460; with chronic conditions) enrolled in a Medicare Advantage program who were identified as nonadherent to treatment and unresponsive to telephone calls became adherent following receipt of a mailed reminder to refill their maintenance prescription(s) [ 66 ].…”