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Architecting Process of Care: A randomized controlled study evaluating the impact of providing nonadherence
Margaret McConnell1, William Rogers2, Emilia Simeonova3
1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Objective:
To test the impact of connecting physicians, pharmacists, and patients to address medication nonadherence, and to compare different physician choice architectures.
Data Sources And Study Setting:
The study was conducted with 90 physicians and 2602 of their patients on medications treating chronic illness.
Study Design:
In this cluster randomized controlled trial, physicians were randomly assigned to an arm where the physician receives notification of patient nonadherence derived from real-time claims data, an arm where they receive this information and a pharmacist may contact patients either by default or by physician choice, and a control group. The primary outcome was resolving nonadherence within 30 days. We also considered physician engagement outcomes including viewing information about nonadherence and utilizing a pharmacist.
Data Collection:
Physician engagement was constructed from metadata from the study website; adherence outcomes were constructed from medication claims.
Principal Findings:
We see no differences between the treatment arms and control for the primary adherence outcome. The pharmacist intervention was 42 percentage points (95% CI: 28 pp-56 pp) more likely when it was triggered by default.
Conclusions:
Access to a pharmacist and real-time nonadherence information did not improve patient adherence. Physician process of care was sensitive to choice architecture.
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