Abstract 11968: An Integrated Intervention Program on Adherence to Treatment with Atorvastatin: Was There an Impact?

Abstract

Background: Medication non-compliance results in 125k deaths/yr. Research indicates that ∼50% of medications are taken correctly, with nonadherence total cost estimates amounting to >$300B.

Hypothesis: An integrated intervention program (3-5 minute nurse counseling session, co-pay relief cards, monthly newsletter on adherence to atorvastatin) would improve adherence.

Methods: An integrated/randomized/prospective/interventional study involving patients >21y who were prescribed atorvastatin at a large cardiovascular physician practice from 3/10-5/11. Patients were excluded if they had previously failed statin treatment. Data originated from the practice’s electronic medical record (EMR) system and was matched and then merged to IMS Health’s Longitudinal (LRx) retail pharmacy data. The primary endpoint was the proportion of days covered (PDC) during the 180 days on or after the index date (the first atorvastatin prescription after study initiation).

Results: 500 patients enrolled in the trial (125 in control arm; 375 in intervention arm). Following data linkage, 53 controls/155 interventions remained in the analysis. Mean age was 67.8y (controls) and 69.5y (intervention); 67.9% and 58.7% were male, respectively. Prevalence of diabetes, hypertension and history of cardiovascular disease events was 30.2%, 96.2%, and 98.1% (controls) and 28.4%, 94.2%, and 85.2% (intervention). Mean 6-month PDC was 0.82 in both arms. Mean PDC for both the new-user control/intervention groups was the same, averaging 0.70 (SD 0.27), while for continuing users, the control group exhibited PDC of 0.83 (SD 0.24) and the intervention group 0.84 (SD 0.22). For continuing users, the control group had mean persistent days of 151.6 (SD 50.2) compared to 150.9 (SD 50.9) for the intervention group. New users had fewer persistent days (control 111.4, SD 69.6; intervention 112.0, SD 58.8) compared to continuing users. Cox proportional hazards model of the risk of discontinuation with index therapy did not show a significant difference between the intervention/control groups (hazard ratio 0.83, p=0.55).

Conclusions: The integrated intervention program did not significantly improve atorvastatin adherence relative to usual care in the studied patient population.