title: Improving adherence to cardiovascular disease medications with information technology.
abstract: OBJECTIVE
  Evaluate the utility of 2 electronic medical record (EMR)-linked, automated phone reminder interventions for improving adherence to cardiovascular disease medications.
  
  
  METHODS
  A 1-year, parallel arm, pragmatic clinical trial in which 21,752 adults were randomized to receive either usual care (UC) or 1 of 2 interventions in the form of interactive voice recognition calls-regular (IVR) or enhanced (IVR+). The interventions used automated phone reminders to increase adherence to cardiovascular disease medications. The primary outcome was medication adherence; blood pressure and lipid levels were secondary outcomes.
  
  
  METHODS
  The study took place in 3 large health maintenance organizations. We enrolled participants who were 40 years or older, had diabetes mellitus or atherosclerotic cardiovascular disease, and were suboptimally adherent. IVR participants received automated phone calls when they were due or overdue for a refill. IVR+ participants received these phone calls, plus personalized reminder letters, live outreach calls, EMR-based feedback to their primary care providers, and additional mailed materials.
  
  
  RESULTS
  Both interventions significantly increased adherence to statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) compared with UC (1.6 to 3.7 percentage points). Adherence to ACEIs/ARBs was also significantly higher for IVR+ relative to IVR participants. These differences persisted across subgroups. Among statin users, IVR+ participants had significantly lower low-density lipoprotein (LDL) levels at follow-up compared with UC (Δ = -1.5; 95% CI, -2.7 to -0.2 mg/dL); this effect was seen mainly in those with baseline LDL levels ≥ 100 mg/dL (Δ = -3.6; 95% CI, -5.9 to -1.3 mg/dL).
  
  
  CONCLUSIONS
  Technology-based tools, in conjunction with an EMR, can improve adherence to chronic disease medications and measured cardiovascular disease risk factors.
authors: Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227. E-mail: William.Vollmer@kpchr.org.
authors: William M
authors: WM
authors: Vollmer
authors: Ashil A
authors: AA
authors: Owen-Smith
authors: Jeffrey O
authors: JO
authors: Tom
authors: Reesa
authors: R
authors: Laws
authors: Diane G
authors: DG
authors: Ditmer
authors: David H
authors: DH
authors: Smith
authors: Amy C
authors: AC
authors: Waterbury
authors: Jennifer L
authors: JL
authors: Schneider
authors: Cyndee H
authors: CH
authors: Yonehara
authors: Andrew
authors: A
authors: Williams
authors: Suma
authors: S
authors: Vupputuri
authors: Cynthia S
authors: CS
authors: Rand
mesh_terms: D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems; D012737:Sex Factors; D012959:Socioeconomic Factors; D013689:Telephone; D016903:Drug Monitoring
chemical_list: D000924:Anticholesteremic Agents; D002317:Cardiovascular Agents; D008055:Lipids