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Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence
BACKGROUND: Medication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team devel...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906179/ https://www.ncbi.nlm.nih.gov/pubmed/36746551 http://dx.doi.org/10.1136/bmjoq-2022-001985 |
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author | Golob, Anna L Geyer, John O'Keeffe, Chatty Nelson, Kaylen Song, Cassandra Vanderwarker, Christopher Britton, Jacqueline Reddy, Ashok Wong, Edwin Schuttner, Linnaea |
author_facet | Golob, Anna L Geyer, John O'Keeffe, Chatty Nelson, Kaylen Song, Cassandra Vanderwarker, Christopher Britton, Jacqueline Reddy, Ashok Wong, Edwin Schuttner, Linnaea |
author_sort | Golob, Anna L |
collection | PubMed |
description | BACKGROUND: Medication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team developed and evaluated a pilot quality improvement programme to assess the feasibility of automatic mailed prescription refills for patients with diabetes and low medication adherence (assessed by medication possession ratio <80%). METHODS: Patients were randomised to usual care with self-initiated refills versus automatic mailed refills for 6 months. Process outcomes included glycaemic control measures (HgbA1C), medication possession ratios for both automatic and self-initiated (reference) refills of medications, patient satisfaction and workforce effort (pharmacist time). RESULTS: Overall, 199 patients were randomised to automatic refills (n=99; 40 of whom participated) versus usual care (n=100). In multivariable analysis adjusting for baseline differences, after 6 months there was no difference in the proportion of patients with follow-up HgbA1C <8% (60.8% automatic refills vs 60.5% usual care, p=0.96). In the automatic refill group, the medication possession ratio for reference medicines was significantly higher than usual care (63.9% vs 54.5%, 95% CI (for difference) 3.1% to 15.9%, p<0.01). CONCLUSIONS: Implications and lessons from this pilot programme include potential beneficial indirect effects from automatic medication refills on patient self-initiated refills of other medications; the importance of tailoring solutions to patient subgroups and specific adherence barriers; and recognition that the rapid deployment, iteration and evaluation of the project was facilitated by a multidisciplinary team embedded within an organisational learning health system. |
format | Online Article Text |
id | pubmed-9906179 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-99061792023-02-08 Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence Golob, Anna L Geyer, John O'Keeffe, Chatty Nelson, Kaylen Song, Cassandra Vanderwarker, Christopher Britton, Jacqueline Reddy, Ashok Wong, Edwin Schuttner, Linnaea BMJ Open Qual Original Research BACKGROUND: Medication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team developed and evaluated a pilot quality improvement programme to assess the feasibility of automatic mailed prescription refills for patients with diabetes and low medication adherence (assessed by medication possession ratio <80%). METHODS: Patients were randomised to usual care with self-initiated refills versus automatic mailed refills for 6 months. Process outcomes included glycaemic control measures (HgbA1C), medication possession ratios for both automatic and self-initiated (reference) refills of medications, patient satisfaction and workforce effort (pharmacist time). RESULTS: Overall, 199 patients were randomised to automatic refills (n=99; 40 of whom participated) versus usual care (n=100). In multivariable analysis adjusting for baseline differences, after 6 months there was no difference in the proportion of patients with follow-up HgbA1C <8% (60.8% automatic refills vs 60.5% usual care, p=0.96). In the automatic refill group, the medication possession ratio for reference medicines was significantly higher than usual care (63.9% vs 54.5%, 95% CI (for difference) 3.1% to 15.9%, p<0.01). CONCLUSIONS: Implications and lessons from this pilot programme include potential beneficial indirect effects from automatic medication refills on patient self-initiated refills of other medications; the importance of tailoring solutions to patient subgroups and specific adherence barriers; and recognition that the rapid deployment, iteration and evaluation of the project was facilitated by a multidisciplinary team embedded within an organisational learning health system. BMJ Publishing Group 2023-02-06 /pmc/articles/PMC9906179/ /pubmed/36746551 http://dx.doi.org/10.1136/bmjoq-2022-001985 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Golob, Anna L Geyer, John O'Keeffe, Chatty Nelson, Kaylen Song, Cassandra Vanderwarker, Christopher Britton, Jacqueline Reddy, Ashok Wong, Edwin Schuttner, Linnaea Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title | Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title_full | Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title_fullStr | Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title_full_unstemmed | Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title_short | Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
title_sort | automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906179/ https://www.ncbi.nlm.nih.gov/pubmed/36746551 http://dx.doi.org/10.1136/bmjoq-2022-001985 |
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