Impact of adherence goal awareness intervention on PDC in various settings: Does awareness help modify medication-taking behavior?

Background: Interventions to improve medication adherence in chronic conditions have shown limited success or sustainability. Previous data revealed that phone calls to patients regarding adherence goal awareness resulted in significant improvement in proportion of days covered (PDC). Objectives: The objective of this study was to explore specific pharmacist adherence interventions via phone in various practice settings. Methods: A prospective, randomized controlled study was conducted with patients who belonged to university-associated health care settings [ambulatory care, chain store, small health plan, and federally qualified health center (FQHC)]. At each site, patients with at least one chronic medication and a calculated PDC < 0.80 were randomized into control (n=115) and intervention (n=126) groups. Control groups (C) received usual pharmacy communication while intervention groups (X) were specifically called by a pharmacist to be informed of PDC goals and their commitment to adherence. PDC values were calculated 3 to 12 months for both groups the time of intervention, then compared with each patient's respective baseline/pre-PDC. Results: Data from a total of 241 patients were pooled to examine change in PDC. There was no significant difference between groups in baseline criteria or PDC. Comparing within groups, there were significant correlations between Pre- and Post-PDCs for the intervention group (X = 0.32 p < 0.05) alone. There were significant improvements from initial PDC to those calculated at the time of Post-intervention PDC within both groups, (C = 0.18 ± 0.28 p < 0.05) and (X = 0.16 ± 0.24, p < 0.05). Approximately 44% of all sampled patients reached their adherence goals (PDC ≥ 0.80) after 3-9 months. Conclusions: Results suggested that patient adherence behavior may improve after any call made by pharmacy staff. This communication and attention from the pharmacy may be enough for patients to consider their medication-taking habits without the need for discussing specific goals and importance of adherence.

Health status utility assessment by standard gamble: a comparison of the probability equivalence and the lottery equivalence approaches.

PURPOSE: Utility values obtained with the standard gamble (SG) method using the probability equivalence approach (PE) have a reported bias due to the "certainty effect." This effect causes individuals to overvalue a positive outcome when it occurs under certainty. Researchers in the decision sciences have proposed an alternative, "lottery equivalence" (LE) approach, using paired gambles, to eliminate this bias. The major objective of the current study was to investigate the certainty effect in health status utility measures and to test our hypothesis that the certainty effect would act in a reverse direction for negatively valued outcomes. METHODS: Fifty-four subjects completed the study by assessing preferences for three health states by rating scale and then by SG using PE as well as LE approaches with assessment lotteries of 0.5 and 0.75. RESULTS: The results from 41 useable responses point towards possible existence of the certainty effect in health in the hypothesized direction: utility values obtained with the PE were significantly lower than with the LEs. There was no significant difference between the LE values indicating elimination of the bias. CONCLUSIONS: The results have important implications since the SG using PE is thought be the "gold standard" in health status utility measurements.

Cost-effectiveness analyses of the conversion of patients with non-insulin-dependent diabetes mellitus from glipizide to glyburide and of the accompanying pharmacy follow-up clinic.

At the Department of Veteran's Affairs Outpatient Clinic in Columbus, Ohio, patients with non-insulin-dependent diabetes mellitus who were receiving glipizide therapy were converted to glyburide therapy over a 6-month period starting in mid-1993. A pharmacy follow-up clinic was instituted to help patients with problems associated with the transition. The conversion was intended to reduce costs by converting from a more expensive to a less expensive drug (in terms of acquisition cost) within the same therapeutic class. An initial analysis of the conversion indicated a savings of $65,000.00 to the Department of Veterans' Affairs (VA) based on the drug acquisition cost differential alone. The purpose of our study was to retrospectively evaluate the cost-effectiveness of the conversion and pharmacy follow-up clinic from the perspective of the VA pharmacy department. Relevant costs and effectiveness (percentage of patients who achieved good glycemic control) were examined for three groups: group I--patients who were treated with glipizide, group II--patients who were treated with glipizide; group II--patients who were switched from glipizide to glyburide, accompanied by a pharmacy follow-up clinic; and group III--patients who were switched from glipizide to glyburide, with no follow-up clinic. Overall, group II had the lowest costs, and group II had to be the most effective. Cost-II effectiveness analysis indicated that, in general, the conversion from glipizide to glyburide was cost-effective. Incremental analysis performed for the follow-up group over the no follow-up group showed that for every 1% of patients who achieved good glycemic control, the VA would spend $1.01 more for the follow-up groups. This was considered to be cost-effective for the VA.