A randomized telephone intervention trial to reduce primary medication nonadherence

Primary medication nonadherence (PMN), defined as patients not picking up an initial prescription, can limit the effectiveness of therapy for chronic conditions. Effective interventions to reduce PMN have not been widely studied or implemented.

To evaluate the ability of an additional nurse-directed telephone intervention to reduce PMN in a cohort of patients with persistent nonadherence after repeated pharmacy-based outreach.

Patients in the Geisinger Health System receiving new (i.e., initially prescribed) prescriptions sent to CVS pharmacies for medications treating asthma, hypertension, diabetes, or hyperlipidemia were identified. As part of existing programs, all patients received 2 automated and 1 live call from CVS pharmacies encouraging them to pick up their prescriptions; those who had canceled their prescriptions or had not picked them up after the 3 pharmacy interventions were eligible for this study. Patients were then randomized, and the intervention group received telephone outreach from a nursing call center to assess reasons for PMN and encourage pickup of prescriptions, with up to 3 attempts to reach each patient. Medication pickup rates were compared across the intervention and control groups.

Initial PMN rates in the overall population were 6%, lower than previously observed in other studies. A total of 290 patients had not picked up their prescriptions after 3 calls from the pharmacy and were enrolled in the study: 142 in the intervention group and 148 controls. The intervention did not change the rate at which patients picked up their prescriptions: 25% of intervention patients did so compared with 24% of control patients. Multivariate models adjusting for patient characteristics and medication classes did not change the results.

In a population of patients who had not picked up new prescriptions after 3 calls from the pharmacy, additional nurse-directed outreach did not improve primary medication adherence. Re-engagement with the prescribing clinician may be needed to improve adherence in this patient population. The low rate of PMN in the overall population differed from prior studies in this setting and others and should be assessed in future research.