A new study shows for the first time that a telephone-based disease therapy management program improves clinical outcomes for rheumatoid arthritis (RA) patients who are receiving injectable medication therapy.
The study, published this month in the Journal of Managed Care Pharmacy, was conducted by Prescription Solutions, a leading pharmacy benefits management organization and a UnitedHealth Group (NYSE: UNH) company.
Patients enrolled in the seven-month-long disease therapy management (DTM) program showed significantly higher adherence to their injectable RA medications compared with a control group of patients who received the same medications through community pharmacies and did not participate in the DTM program. Adherence is the extent to which a patient continues the mode of treatment recommended by the physician or health care professional.
The average adherence rate for patients in the DTM program was 83 percent, compared with an average adherence rate of 60 percent for patients in the control group. These findings provide important insights into the benefits DTM programs provide in helping patients better manage their health.
“This is an important advance in showing how to improve patients’ lives further when using injectable, biological drugs, which slow the progression of rheumatoid arthritis,” said Joseph Addiego, M.D., chief medical officer, Prescription Solutions. “Higher adherence to this medication encouraged by pharmacist or nurse phone calls translates to better physical health for patients, which is a positive step forward.”
Disease-modifying antirheumatic drugs (DMARDS) have been shown to be most effective for controlling rheumatoid arthritis, but for many patients, adhering to these medications is challenging. Some patients fear the self-injection required for many of the newer DMARDS and others complain of injection-site reactions or the drugs’ high cost. Any or all of these factors can cause some patients to abandon their course of treatment. This has a significant impact on health outcomes and health costs.
Patients who enrolled in Prescription Solutions’ DTM program received telephone consultations with a licensed pharmacist or registered nurse. During each telephone consultation, the pharmacist or nurse educated the patient about his or her medical condition, self-management skills, side-effects management and the importance of medication adherence and persistence. This DTM program was offered in addition to routine specialty pharmacy management services provided by Prescription Solutions, which include medication educational brochures, mail service medication delivery, refill reminders, and access to a pharmacist 24 hours a day, 7 days a week.
Patients who completed the seven-month RA DTM program had improvements in physical functioning manifested by significant improvements in the SF-12 physical component and HAQ-DI scores (validated instruments to measure health-related quality of life and physical functioning). However, the study did not demonstrate improvements to SF-12 mental scores or work productivity. Work productivity results were available for only a small number of patients (only 18.6 percent of the study patients were employed), making it difficult to interpret these results.
Prescription Solutions routinely conducts scientific studies on various disease states as a way to use its clinical expertise to advance the practice of medicine and add to the scientific literature. This is a key element of Prescription Solutions' ongoing search for the most current, highest-quality evidence available to further its goal of continuously improving the cost-effectiveness of patient medications and drug treatment outcomes. The company’s DTM programs are intended to help patients more clearly understand the importance of proper treatment for their disease, to more effectively manage their disease symptoms or medication side effects, and to provide support to help patients overcome other obstacles to improved health and proper care, such as addressing stress-related issues or financial hardship.
Participants in the study were stratified into three patient cohorts: DTM, specialty pharmacy and community pharmacy. DTM patients were further categorized into a DTM intent-to-treat cohort (all 340 DTM-enrolled patients) and a DTM completer cohort (subset of DTM patients). DTM completer, specialty and community pharmacy cohorts were matched 1:1:1 using a propensity score that represented the likelihood of completing the DTM program. The primary outcome was adherence to injectable RA medications, represented as the proportion of days covered over an eight-month post-identification period. Patient-reported outcomes were evaluated among all 371 DTM patients who completed the seven-month consultations regardless of whether they met continuous enrollment requirements.
About Prescription Solutions
Prescription Solutions is an innovative pharmacy benefit management company managing the prescription drug benefit of commercial, Medicare and other governmental health plans, as well as those of employers and unions. A UnitedHealth Group company, Prescription Solutions serves customers through a national network of 64,000 community pharmacies and state-of-the-art mail service pharmacies in Carlsbad, Calif., and Overland Park, Kan., both of which have earned the prestigious Verified Internet Pharmacy Practice Sites™ (VIPPS®) accreditation by the National Association of Boards of Pharmacy® (NABP®). Prescription Solutions also won a Platinum Award for URAC’s Best Practices for Consumer Empowerment and Protection Awards for the Multiple Sclerosis/Disease Therapy Management Program (2010), and two Silver Awards: the Drug Interaction Alert Program (2009) and Geriatric RxMonitor Program (2008). Additional information can be found at www.prescriptionsolutions.com.
About UnitedHealth Group
UnitedHealth Group (www.unitedhealthgroup.com) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of health benefit programs through UnitedHealthcare, Ovations and AmeriChoice, and health services through Ingenix, OptumHealth and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves 75 million people worldwide.