title: Outcomes of a rheumatoid arthritis disease therapy management program focusing on medication adherence.
abstract: BACKGROUND
  A national pharmacy benefits management company implemented a rheumatoid arthritis (RA) disease therapy management (DTM) program as an enhanced offering to patients receiving specialty pharmacy services. The program was designed to improve medication adherence, maximize therapeutic outcomes, and enhance physical functioning and health-related quality of life (HRQOL) by empowering patients and improving their knowledge of RA.
  
  
  OBJECTIVE
  To evaluate (a) adherence to injectable RA medications for patients participating in an RA DTM program compared with nonparticipating patients receiving injectable RA medications at specialty or community pharmacies and (b) HRQOL, work productivity, and physical functioning before versus after completing the RA DTM program.
  
  
  METHODS
  Patients who had an RA diagnosis and a pharmacy claim for an injectable RA medication during the identification period (August 2007 through September 2008) and were continuously enrolled with the plan from 4 months before through 8 months after the identification date were stratified into 3 patient cohorts: DTM, specialty pharmacy, and community pharmacy. DTM patients were further categorized into a DTM intent-to-treat (ITT) cohort (all 340 DTM-enrolled patients) and a DTM completer cohort (subset of 266 ITT patients who completed the month 6 consultation). DTM completer, specialty, and community pharmacy cohorts were matched 1:1:1 (n = 244 in each cohort after matching) using a propensity score that represented the likelihood of completing the DTM program. The primary outcome was adherence to injectable RA medications, measured as the proportion of days covered (PDC) over an 8-month post-identification period. Patient-reported outcomes (short form [SF]-12, Work Productivity Activity Impairment [WPAI], and Health Assessment Questionnaire-Disability Index [HAQ-DI]) were evaluated among all 371 DTM patients who completed the month 0 and month 6 consultations regardless of whether they met continuous enrollment requirements (patient-reported sample).
  
  
  RESULTS
  Of specialty pharmacy patients, approximately 14% chose DTM participation. During the post-identification period, mean PDC was 0.83 for DTM ITT, 0.89 for DTM completer, 0.81 for specialty pharmacy, and 0.60 for community pharmacy patients. Differences were statistically significant for both DTM cohorts compared with the community pharmacy cohort (P < 0.001) and for the DTM completer cohort compared with the specialty pharmacy cohort (P < 0.001), but not for the DTM ITT cohort compared with the specialty pharmacy cohort (P = 0.291). In the patient-reported sample, mean SF-12 physical component scores significantly increased by 1.1 points (P = 0.048); mean SF-12 mental component scores were not significantly changed (P = 0.679); mean WPAI work productivity decreased by 10.8 percentage points (P = 0.045); and mean HAQ-DI scores significantly improved by 0.08 points (P < 0.001).
  
  
  CONCLUSIONS
  Patients participating in the RA DTM program had significantly higher injectable RA medication adherence compared with community pharmacy patients. Adherence to injectable RA medications was significantly higher for patients completing the RA DTM program, but not for the DTM ITT group, compared with patients receiving specialty pharmacy services alone. Patients completing the RA DTM program experienced improvements in SF-12 physical component and HAQ-DI scores but did not demonstrate improvements to SF-12 mental scores or work productivity.
authors.affiliation: Department of Clinical Services, Prescription Solutions, Irvine, CA 92614, USA. karen.stockl@prescriptionsolutions.com
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stockl
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Shin
authors.forename: Heidi C
authors.initials: HC
authors.lastname: Lew
authors.forename: Armen
authors.initials: A
authors.lastname: Zakharyan
authors.forename: Ann S M
authors.initials: AS
authors.lastname: Harada
authors.forename: Brian K
authors.initials: BK
authors.lastname: Solow
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Curtis
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010594:Pharmacies; D011788:Quality of Life; D012017:Referral and Consultation; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents