< Back
|
|
Innovation Attempt:
|
|
Faxed Physician Reminders Fail to Improve Antidepressant Adherence
|
|
|
|
 Snapshot
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.
|
begin doDeveloping OrganizationsHarvard Pilgrim Health Care
end dobegin ppPatient Population
Geographic Location > Region; Vulnerable Populations > Mentally ill end pp |
|  |
Problem AddressedAntidepressants 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 follow up 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.
begin pqmxmlPertinent 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.
end pqmDescription 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:
- 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.
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.
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]
Contact the InnovatorNeil Minkoff, MD
Harvard Pilgrim Health Care
E-mail: Neil_Minkoff@harvardpilgrim.org
|
|
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.
|
|
Comment on this innovation/Read other comments.
| Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more. |
|
1 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] 3 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] |
|
|
Original publication: April 14, 2008.
Last updated: May 13, 2009.
|
 |
|
|
