Executive Summary
Telephonic outreach has been found to have a positive impact on medication adherence. For this white paper, medication adherence will be measured using the proportion of days covered (PDC), a widely used method for calculating medication adherence using pharmacy data.
Studies have shown that telephonic reminder calls can increase PDC, indicating better medication adherence. Telephonic outreach provides individuals with a personal connection to their health team, education and support, and helps identify and address barriers to adherence. Individuals who feel that their health team cares about their well-being are more likely to engage in their own care and take their medications as prescribed.
Understanding the strong connection between medication adherence and health outcomes, Vita Valens developed this research study to look at telephonic engagement as a method of promoting medication adherence within adults in New York City. This white paper shares how engaging with individuals on medication adherence and offering resources, education, compassion and support can increase the number of individuals taking their medications as prescribed. Vita Valens discusses the impact of telephonic engagement on health promoting behaviors, barriers to medication adherence and strategies for overcoming the challenges.
Vita Valens’ Engagement team was formed to directly engage with individuals with an identified gap in medication adherence. As a part of our mission to improve older adults’ physical and emotional health and well-being in New York City, we believe that genuine and compassionate connections, support, and quality care are essential to supporting positive health outcomes. Outreach and engagement allows our health teams to connect with individuals on a personal level, identify and address barriers to adherence, provide education, and help individuals stay on track with their medications.
Background
Older adults have significantly increased rates of chronic conditions[1]. The National Council on Aging reported that almost 95% of adults over the age of 65 have at least one chronic condition, and four out of five older adults have at least two chronic conditions. Chronic conditions can significantly impact the quality of life and lead to functional limitations, disability, and even mortality. Additionally, older adults experience high rates of mental health conditions such as depression, anxiety, and social isolation, which can exacerbate physical health conditions[1].
Health promoting behaviors such as medication adherence, annual well visits, and preventive screenings can help older adults manage their health conditions and improve overall health outcomes[2]. While it is clear the benefit of healthy behaviors, there are many barriers to accessing and utilizing healthcare services, such as mobility issues, financial burden, transportation challenges, limited social support networks, and many other social and structural factors that influence individuals’ ability to carry out positive healthy behaviors.
It is well understood that health behaviors are not solely individual choices. Individual behaviors are situated in the larger context of interpersonal relationships, institutions, communities, and society. Understanding this, creating environments that enable healthy behaviors is essential.
Telephonic engagement has emerged as a strategy for addressing some barriers to health promoting behaviors and providing additional support to individuals to enable chronic care management and health improvement. Telephonic engagement involves the use of phone calls to provide coaching, support, and education to individuals. Other interventions, such as reminder calls and text messages, are also valuable methods of encouraging health promoting behaviors. The use of such programs offers great potential to reach individuals and provide supportive services and resources to enable behaviors that promote health.
Methodology
For this study, we analyzed the efficacy of telephonic outreach on medication adherence through utilizing pharmacy record panel data. Individuals identified as at risk were prioritized for intervention. At risk was defined as pharmacy refill records that showed a lapse in days between the last medication refill date and when the next prescription was due if taken as prescribed.
In this study, medication adherence, or compliance, is measured through pharmacy refill records to determine
the proportion of days covered (PDC). Medications followed and prioritized for this analysis were prescribed and
medically necessary for the treatment of Diabetes, High Blood Pressure and High Cholesterol.
Utilizing pharmacy data through our partnership with New York Network Management IPA, Vita Valens’ Engagement Team conducted daily outreach calls to identified individuals over the course of the one year study period. Care gap reports were pulled on a semiweekly basis from the pharmacy record panel and individual outreach was assigned to a specific engagement team member. Each Engagement Specialist was responsible for contacting and following up as applicable with the individuals assigned to them to build rapport and trust with the individual.
Data from 2021, prior to the implementation of the telephonic intervention, was used to establish baseline medication compliance rates. 2022 compliance rates were compared to existing baseline data to analyze the impact of telephonic outreach from a dedicated engagement specialist on medication adherence. Both data sets contained unique but demographically similar individuals.
At Risk Individuals
Pharmacy refill records were used to identify individuals at risk for medication adherence.
One Year Study
The engagement team conducted daily outreach calls to identified individuals over the course of the one year study period.
Data Collection
Data from 2021, prior to the implementation of the telephonic intervention, was used to establish baseline medication compliance rates.
Compliance Rates
2022 compliance rates were compared to the baseline data to analyze the impact of telephonic outreach.
Results
Of the panel members identified for outreach (n=1828) in 2022, 60% of the panel received at least one call from an Engagement Specialist. On average, each individual received 1.8 touch points with one having as many as 11 discrete points of contact.
Across all three chronic conditions (Diabetes, High Blood Pressure, and High Cholesterol), there was an increase
in medication adherence, as reflected by a greater PDC calculated in 2022 compared to 2021. PDC is calculated
by dividing the total days that an individual had medication available by the total number of days in a specific
time period. The specific time period measured was the total days the prescription covered, typically in units of
30, 60 or 90 days across January 1st – December 31st for the years 2021 and 2022. The increase in adherence rates
observed ranged from 4.73% to 6.14% based on the chronic condition.
The below table summarizes the medication adherence results from the two time frames analyzed.
60+ participants with identified social needs (n=13)
|
Measure |
2021 Member |
2022 Member |
2022 Members |
2021 |
2022 |
Change |
|---|---|---|---|---|---|---|
|
Diabetes |
199 |
372 |
324 |
81.00% |
87.10% |
6.10% |
|
Blood Pressure |
428 |
709 |
622 |
84.00% |
87.73% |
4.73% |
|
Cholesterol |
432 |
747 |
636 |
79.00% |
85.14% |
6.14% |
This white paper shares insights from high level annual data on medication adherence compliance and the potential benefit of telephonic outreach to adults in New York City at risk for medication non adherence.
This study had several limitations. One notable limitation is that the sample size increased significantly from 2021 to 2022. A second limitation is that the study did not look at individual changes from one year to the next. The study used two distinct sample populations and cannot draw conclusions on behavior change at the individual level. Other limitations include external factors that are out of the control of the researchers. These limitations impact the generalizability of the study and affirm the need for future studies to address data collection methods at an individual level to correlate telephonic outreach and support on medication compliance and health outcomes.
Conclusion/ Recommendations
This white paper contributes to and aligns with the results of other existing studies and literature that demonstrate the positive impact of telephonic outreach on medication adherence. Individuals who feel that their care team is invested in them are more likely to take their medications as prescribed. Telephonic outreach can help to identify and address barriers to adherence such as side effects, pharmacy location, transportation barriers and misunderstanding around the prescriber’s instructions. Speaking with individuals allows the health team to develop individualized solutions, provide education, and share tips for staying on track. The health team can also provide encouragement, praise and motivation to the individual.
Additionally, this white paper highlights the value of pharmacy data. Pharmacy data can provide valuable information on medication adherence to identify individuals who may need additional support or interventions to improve adherence and ultimately improve health outcomes. As a result of this analysis, Vita Valens continues to prioritize the growth and scope of our engagement team by investing in tools to capture robust data for future studies and analyses that will facilitate study process and outcome measurement. Vita Valens, through improved and individualized data collection capabilities, continues to build meaningful support programs that impact identified barriers and build supportive resources within the population of older New Yorkers.
