SummaryTo improve care for patients diagnosed with depression, a health plan used real-time pharmacy data to automatically generate faxed alerts that informed physicians when patients were not complying with their antidepressant regimen. This intervention did not succeed in improving patients' adherence with their treatment plans.
Developing OrganizationsHarvard Pilgrim Health Care
Antidepressants are very effective in reducing symptoms, relapse, and the recurrence of depression when taken continuously for a minimum of 6 months. However, studies have found that the rate of adherence to this regimen is low.1 Moreover, physicians typically have no way of knowing that a patient has not refilled a prescription until the patient returns for a followup visit.
Performance on measures of antidepressant management has been consistently low across health plans,2 including those—like Harvard Pilgrim Health Care—that perform well on other measures. This health plan decided to target medication management as part of its strategy to improve performance on HEDIS® (Healthcare Effectiveness Data and Information Set) measures.
Pertinent Quality MeasuresHEDIS: Antidepressant Medication Management
- Effective acute phase treatment: The percentage of eligible members who received effective acute phase treatment after a new episode of depression.
- Effective continuation phase treatment: The percentage of members who received effective continuation phase treatment by remaining on antidepressant medication continuously in the 6 months after a new episode of depression.
Description of the Innovative ActivityTo address the compliance problem, Harvard Pilgrim Health Care developed a program of automated faxed alerts tied to real-time pharmacy claims data. The faxes notified the physicians when patients did not refill prescriptions and thus were not following the prescribed treatment. Key elements of the program are described below:
Although the goal of the intervention was to prompt physicians to follow up with their patients, the health plan did not conduct training with physicians, nurses, or their medical office staff to ensure that they knew what to do with the faxed information. In addition, no followup was done to determine whether and how the physicians actually used the faxes.
- Initial notification to physicians about noncompliant patients: The program identified patients who were beginning treatment with antidepressants (defined as no use in the previous 100 days) and followed them for 6 months. If eligible patients did not refill their antidepressant prescription for at least 10 days beyond the date when the previously dispensed prescription should have been completed, a letter was automatically faxed to the prescribing physicians alerting them to the situation.
- Followup notification for patients with additional gaps: If the targeted patients refilled their antidepressant prescription within a 30-day time frame (i.e., within 20 days of the initial alert), they were considered adherent and continued to be monitored by the program. A subsequent gap of 10 days in the same 6-month treatment episode could trigger another fax alert.
- Discontinuation of chronic noncompliers: If the patients did not refill their antidepressant prescription within 30 days, they were considered nonadherent for the treatment episode and were no longer tracked. They could reenter the program if they restarted treatment with antidepressants after a gap of 100 days.
ResultsThis innovation had no impact on compliance with antidepressant prescriptions.
Analyses conducted by researchers affiliated with Harvard Medical School found that over a 2-year period, the proportion of nonadherent patients among those with delayed refills (i.e., refill gaps of more than 10 days) remained relatively constant, averaging 75 percent.3 Based on these findings, the health plan decided to discontinue the intervention.
Contact the InnovatorRichard Weisblatt, PhD
Senior Vice-President for Provider Network and Product Development
Harvard Pilgrim Health Care
93 Worcester Street
Wellesley, MA 02481
Innovator DisclosuresDr. Weisblatt has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile.
References/Related ArticlesBambauer KZ, Adams AS, Zhang F, et al. Physician alerts to increase antidepressant adherence: fax or fiction? Arch Intern Med. 2006;166(5):498-504. [PubMed]
Bambauer KZ, Soumerai SB, Adams AS, et al. Provider and patient characteristics associated with antidepressant nonadherence: the impact of provider specialty. J Clin Psychiatry. 2007;68(6):867-73. [PubMed]
Bambauer KZ, Adams AS, Zhang F, et al. Physician alerts to increase antidepressant adherence: fax or fiction? Arch Intern Med. 2006;166(5):498-504. [PubMed]
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Original publication: April 14, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: July 17, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: May 12, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.