OBJECTIVES: To examine the effect of a pharmacist telephone intervention on preventing medication discontinuation of ACE-Is/ARBs among non-adherent hypertensive patients with diabetes enrolled in a Texas-based Medicare Advantage plan. METHODS: The health plan medical claims data was used to identify patients with hypertension and diabetes diagnoses and at least 2 fills for ACE-Is or ARBs between January/2013- October/2013. Patients who failed to refill their medication for more than one day, and had a proportion of days covered (PDC) <0.8 were considered non-adherent and contacted by a pharmacist by phone. Multivariate logistic regression was conducted to assess the intervention effect on medication discontinuation during the 6 months post-intervention. The outcome variable was a categorical variable of continuing (yes) vs discontinuation (no). Major independent variable was intervention (yes/no). Other control variables included were demographics, physician specialty, health plan, CMS Risk Score, Charlson comorbidity index and number of other medications.  RESULTS:

In total, 186 hypertensive diabetic patients, non-adherent to ACE-Is/ARBs (PDC<0.8) were identified. Among these patients, 29 patients switched to other drug classes for treating diabetes and hypertension. After excluding those who switched, 157 patients were included in the logistic regression model with 131 continuing to use ACEI/ARBs and 26 discontinuing the ACEI/ARBs. Intervention and comorbidity index were found to be significantly associated with medication discontinuation. Patients who received intervention were more likely to persist with ACEI/ARBs (OR: 3.56, 95% CI: 1.06-11.86). Patients with higher CCI were more likely to discontinue and less likely to persist with ACEI/ARBs (OR: 0.72, 95% CI: 0.53-0.99). Other covariates were not significantly associated with medication discontinuation. CONCLUSIONS:

The brief pharmacist call was effective in preventing medication discontinuation. Future longer term studies are warranted to evaluate the effect of such interventions with other adherence outcomes such as proportion of days covered (PDC) and clinical outcomes like blood pressure control.