Architecting Process of Care: A randomized controlled study evaluating the impact of providing nonadherence information and pharmacist assistance to physicians

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02306122.

Keywords: adherence; behavioral economics; choice architecture; defaults; pharmacists; phone-based interventions.

© Health Research and Educational Trust.

Figures

Figure 1

Patient and physician flow through enrollment, randomization and follow‐up

Figure 2

Experimental design [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Physician responses [Color figure can be viewed at wileyonlinelibrary.com]