Physician Education and Improvements in Patient Adherence

Cincinnati—Three healthcare organizations (a managed care company [Aetna], a pharmaceutical manufacturer [Pfizer], and a quality improvement company [Total Therapeutic Management, Inc. (TTM)], recently completed a 16-month project to educate physicians via educational materials focusing on improving patient adherence to antidepressant medication as part of a study to determine whether adherence rates improved during the course of the intervention. Representatives from each of the 3 organizations presented a Pharmacy Partnership Briefing session at the AMCP meeting.

The intervention, titled the Depression Medication Adherence and Quality Improvement Program, was designed to (1) implement physician and patient education interventions to improve adherence to an antidepressant medication regimen, (2) utilize health plan member and provider data to generate provider reports, patient clinical summaries, and outcome analysis related to patient adherence to antidepressant medication, and (3) assess changes in antidepressant medication adherence to evaluate the impact of program interventions.

Mary Alvarez, PharmD, director, medical affairs, US national accounts at Pfizer, outlined Pfizer’s commitment to innovative healthcare collaborations, saying that this intervention supports the company’s “interest in utilizing real-world data and evidence-based medicine to understand how targeted interventions may help improve medication adherence and the management of patients with depression.”

She added that Aetna’s expertise in healthcare management, TTM’s clinical engagement experience, and Pfizer’s expertise in research and development was used to combine data, interventions, and scientific research to “better understand provider/patient needs and the effectiveness of clinical interventions.”

Mary Gizzi, business project program manager at Aetna, described Aetna’s perspective: “The Aetna Behavioral Health national work group viewed this program as an opportunity to measure and improve the Antidepressant Medication Management Health Effectiveness Data and Information Set (HEDIS) measure. This pilot provided a series of data points indicating medication management in depression and also provided educational components to improve adherence in the use of antidepressant medications.”

Aetna’s role in the program included contributing to the study design, determining the market (Philadelphia), delivery of the data to TTM, and dissemination of study results to Aetna’s Quality Team.

Katie Stringer, PhD, director of outcomes research at TTM described TTM as a “quality improvement company that specializes in academic detailing and outcomes research through medical chart review,” often bridging relationships between pharmaceutical companies and managed care.

TTM also contributed to the study design, aided in project coordination and logistics, performed the analysis of the claims data, created the report, developed the patient and physician educational tools, and worked on the evaluation of the results, Dr. Stringer said.

Outcome measures were (1) adequate antidepressant treatment according to American Psychiatric Association guidelines, (2) effective acute and continuation treatment according to HEDIS, and (3) overall adherence.

Using Aetna’s medical and pharmacy claims data from 2009-2011, the program assessed antidepressant medication adherence at baseline and 3, 6, 9, and 12 months postintervention. One year after the first set of interventions, patient adherence to antidepressant medication showed statistically significant increases for the National Committee for Quality Assurance (NCQA) acute phase. Overall adherence remained relatively stable during the NCQA continuation phase, suggesting that boosters may be needed to continually improve adherence.

In conclusion, Dr. Stringer commented that the project highlighted a successful collaboration of Aetna, Pfizer, and TTM to implement and assess an antidepressant medication adherence program and that academic detailing, using real-world data, was well received by physicians.