1. HYPERTENSION DIABETES DYSLIPIDEMIA Evaluation of Member Survey Responses to a Medication Therapy Management Clinical Education Program and the Impact of Written Educational Materials on Member Medication Adherence Se Kwon Song, PharmD; Claire Wei, MS; Karen Stockl, PharmD; Heidi Lew, PharmD; Jennifer Shin, PharmD; Brian Solow, MD; Bradford Curtis, MD. Prescription Solutions, Department of Clinical Services, Irvine, CA Introduction Objectives Study Methods To determine member satisfaction with WEMs provided as part of the MTM clinical education program To assess whether favorable responses to the clinical education program were influenced by differences in member characteristics (age, gender, disease state, and chronic disease score [CDS] 2 ) To examine the impact of WEMs on medication adherence Intervention: Members enrolled in Prescription Solutions MTM program were sent WEMs regarding medication management of their medical condition(s). The WEMs were designed to enhance member knowledge and understanding of healthy lifestyle, disease-specific medications including their potential benefits and side effects, and cost-saving tips. Surveys to measure member satisfaction with the WEMs were mailed along with the WEMs. The survey that was administered was the comprehensibility subscale of the Consumer Information Rating Form (CIRF), a validated survey to measure member satisfaction with WEMs. 3 The survey consisted of 5 questions which asked members to rate how easy or hard the WEMs were to: 1) read, 2) understand, 3) remember, 4) locate important information, and 5) keep for future reference. Study Design: Retrospective cohort study Data source: pharmacy claims and returned satisfaction surveys from Medicare Advantage-Prescription Drug [MAPD] and Prescription Drug Plan [PDP]) members participating in the MTM program Index date: WEM (intervention) mailing date Pre-intervention period: 180 days prior to index date Post-intervention period: 180 days after index date Inclusion Criteria: Member must have met 2008 MAPD MTM program criteria during the first or second quarter of 2008. The criteria for MTMP interventions were: Beneficiaries who were likely to incur at least $4,000 in annual drug expenditure for Part D-covered medications Beneficiaries who filled eight or more distinct covered Part D medications Beneficiaries who had at least three of the ten diagnoses of interest Member must have participated in the 2008 MTM clinical education program for disease(s) of interest (arthritis, coronary artery disease [CAD], diabetes [DM], depression, dyslipidemia, gastrointestinal [GI], congestive heart failure [CHF], hypertension [HTN], osteoporosis, and respiratory disease [RD]). Member must have returned correctly completed member satisfaction survey(s), where all questions must have been answered with only one box checked. Survey Scoring and Categorization: Each of the 5 survey questions were scored as follows depending on the member’s response: Very easy = 5; Quite easy = 4; In between = 3; Quite hard = 2; Very hard = 1 Favorable responders: Members with a score of 4 or higher for all 5 questions Unfavorable responders: Members with a score of 2 or lower for all 5 questions Intermediate responders: Members that did not meet the criteria for favorable or unfavorable responders Primary Analysis: Logistic regression analysis was performed to investigate whether health plan, age, gender, disease state, or CDS were a factor in the odds ratio of a favorable response compared to an unfavorable response. Secondary Analysis: The secondary analysis was to compare medication adherence of members who had HTN, DM, or dyslipidemia during the pre- and post-intervention periods by measuring medication possession ratio (MPR) between members who responded favorably and unfavorably to the WEMs. Medication possession ratio = sum of days supply of prescriptions for target medications filled during the follow-up period divided by the number of days between the first claim for target medication during the follow-up period and the last claim for target medication during the follow-up period plus the days supply for the last prescription fill for target medication during the follow-up period. Medication possession ratio was truncated at 1. Members were identified if they had a prescription fill for an antihypertensive, antidiabetic, or an antihyperlipidemic during the pre- and post-intervention period. The Medicare Modernization Act of 2003 required all Part D prescription drug sponsors to establish a medication therapy management (MTM) program designed to optimize therapeutic outcomes by improving medication use and reducing medication waste and adverse events. 1 The use of written educational materials (WEMs) continues to be an important tool for educating members about their medication(s) and/or disease state(s) and the importance of medication adherence. In 2008, Prescription Solutions, a national pharmacy benefit management (PBM) company, provided WEMs to Medicare Part D members as part of its MTM clinical education program. We conducted an analysis to measure member satisfaction with the WEMs provided as part of their MTM program. REFERENCES 1.Medicare Part D Medication Therapy Management (MTM) Programs 2008 Fact Sheet. Centers for Medicare and Medicaid Services Web Site. http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/MTMFactSheet.pdf Updated March 19, 2008. Accessed August 21, 2009. 2.Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992;45:197-203. 3.Koo M, Krass I, Aslani P. Evaluation of written medicine information: validation of the Consumer Information Rating Form. Ann Pharmacother.. 2007;41:951-956. Results Table 1: Survey Responder Characteristics (N = 35,569) Presented at the Academy of Managed Care Pharmacy 22 nd Annual Meeting and Showcase, San Diego, CA – April 7-10, 2010. For more information, please contact Prescription Solutions via telephone: (949) 252-6856 or e-mail: Se_K_Song@prescriptionsolutions.com © 2010 Prescription Solutions. This document is proprietary to Prescription Solutions and is subject to federal copyright protection. Any reproduction, dissemination or use of this document without the express prior written consent of Prescription Solutions is strictly prohibited. Mean survey scores indicate that members found the information in Prescription Solutions’ WEMs to be quite easy to read, understand, remember, locate, and keep. Approximately 69% of members responded favorably to the Prescription Solutions’ WEMs with survey responses of “very or quite easy” for all 5 of the survey questions. Member characteristics that had the largest influence on the likelihood of a member responding favorably to the WEMs were arthritis, dyslipidemia, and participation in a MAPD plan. CDS, age less than 65 years, male gender, and history of gastrointestinal illness or osteoporosis had the least influence on the likelihood of a member responding favorably to the WEMs. Prior to the intervention, medication adherence was high for the subgroup of members with hypertension, diabetes, and dyslipidemia, which remained steady during the post-intervention period. Responses may not reflect those of all members who received the intervention because only returned surveys could be evaluated. Since the majority of members responded favorably to the survey, the number of unfavorable responders used as a comparator group was small relative to the favorable responders group. Members had a high baseline MPR prior to the intervention which made it difficult to observe the impact of WEMs on medication adherence. Results in a population with poor adherence may be different. Table 2: Characteristics of Members Included in Secondary Analysis CharacteristicsFavorableUnfavorableP-value Hypertension Number of members11,194247 - PDP (n, %)9,924 (88.7)225 (91.1) <0.01 Age (mean, SD)70.4 (11.0)72.2 (12.7) 0.02 Female (n, %)7,798 (69.7)151 (61.1) <0.01 CDS (mean, SD)6.41 (3.22)6.19 (3.16) 0.29 Diabetes Number of members6,232131 - PDP (n, %) 5,328 (85.5)117 (89.3)<0.01 Age (mean, SD) 68.9 (11.0)70.3 (12.2)0.14 Female (n, %) 4,034 (64.7)68 (51.9)<0.01 CDS (mean, SD) 7.08 (3.07)6.27 (2.76)<0.01 Dyslipidemia Number of members10,278199 - PDP (n, %) 8,770 (85.3)176 (88.4)<0.01 Age (mean, SD) 70.0 (10.9)71.0 (12.7)0.23 Female (n, %) 7,018 (68.3)118 (59.3)<0.01 CDS (mean, SD) 6.28 (3.21)6.01 (3.11)0.23 Discussion Limitations Figure 2: Logistic Regression Analysis Evaluating the Likelihood of Specific Member Characteristics to Contribute to a Favorable Response Figure 4: MPR Pre- and Post-Intervention Period of Members With HTN, DM, and/or Dyslipidemia Odds Ratio Conclusions Based on the survey results, the majority of members had favorable ratings of WEMs provided as part of a MTM program. Differences in member characteristics appeared to influence member satisfaction with WEMs with MAPD members and members with arthritis or dyslipidemia having the highest likelihood of a favorable response. Minimal changes in MPR were observed with WEMs, possibly due to the high adherence rate prior to the intervention. Characteristics Favorable Responders Intermediate Responders Unfavorable Responders P-value* Number of members23,90011,022647 - Age (mean, SD)70 (11)69 (12)72 (12)<0.01 Female (n, %)16,887 (70.7)7,444 (67.4)397 (61.4)<0.01 PDP (n, %)20, 735 (86.8)9,602 (87.1)592 (91.5)<0.01 Arthritis (n, %)1,123 (2.2)411 (1.9)12 (1.1)<0.01 CAD (n, %)3,230 (6.4)1,282 (5.8)68 (6.1)<0.01 CHF (n, %)899 (1.8)381 (1.7)18 (1.6)<0.01 Depression (n, %)6,731 (13.4)3,038 (16.4)160 (14.4)<0.01 DM (n, %)6,411 (12.8)2,502 (11.3)141 (12.7)<0.01 Dyslipidemia (n, %)10,286 (20.5)4,540 (20.5)215 (19.4)<0.01 GI (n, %)7337 (14.6)2,931 (13.2)171 (15.4)<0.01 HTN (n, %)10,987 (21.9)5,352 (24.1)259 (23.3)<0.01 Osteoporosis (n, %) 2,916 (5.8)1,012 (4.6)64 (5.8)<0.01 RD (n, %)263 (0.5)122 (0.6)3 (0.3)<0.01 CDS (mean, SD)6.30 (3.27)6.30 (3.31)6.03 (3.16)0.04 *Comparison between favorable and unfavorable responders Figure 3: Mean Member Survey Response Scores* by Question** (N = 72,865 surveys) *Each question scored on a scale of 5 (very easy) to 1 (very hard) Figure 1: Member Satisfaction with WEMs (N = 72,865 surveys) Data points in blue are statistically significant **Question was phrased “Overall, how easy or hard would you say the information in this education piece is to: …”