Use of health information technology to improve medication adherence.
OBJECTIVE
To evaluate the effectiveness of an intervention based on health information technology (HIT) that used speech recognition software to promote adherence to inhaled corticosteroids (ICS) among individuals with asthma who were members of a large health maintenance organization.


METHODS
Pragmatic randomized clinical trial.


METHODS
Adults with asthma enrolled in a large managed care organization (N = 8517) were randomized to receive either usual care or an interactive voice recognition (IVR) intervention designed to prompt medication refills and improve ICS adherence. The primary outcome was ICS adherence as measured by modified medication possession ratio calculated from the electronic medical record (EMR). Secondary measures included survey- and EMR-based measures of asthma morbidity.


RESULTS
Our primary analyses found that ICS adherence increased modestly but significantly for participants in the intervention group relative to those in the usual care group ( Δ= 0.02, 95% confidence interval 0.01-0.03), with a baseline adherence of 0.42 in both groups. No difference was observed in asthma morbidity measures. In post hoc analyses of participants receiving 2 or more direct IVR contacts or detailed messages, the intervention effect was more marked. The overall effect was triple that observed in the primary analyses (0.06 vs 0.02), and significant differences were observed between groups in asthma control.


CONCLUSIONS
An HIT-based adherence intervention shows potential for supporting medication adherence in patients with chronic diseases such as asthma. However, additional research is needed to determine how best to enhance the reach and effectiveness of such interventions.
Center for Health Research, 3800 N Interstate Ave., Portland, OR 97227-1110, USA. william.vollmer@kpchr.org
William M
WM
Vollmer
Adrianne
A
Feldstein
David H
DH
Smith
Joan P
JP
Dubanoski
Amy
A
Waterbury
Jennifer L
JL
Schneider
Shelley A
SA
Clark
Cynthia
C
Rand
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D016001:Confidence Intervals; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008490:Medical Informatics / Q000295:instrumentation / Q000458:organization & administration*; D055118:Medication Adherence; D008875:Middle Aged; D016012:Poisson Distribution; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents