Abstract
Rationale: Adherence to ICS among individuals with asthma is poor and associated with increased asthma symptoms and acute health care utilization; diminished quality of life; and increased health care costs.
Objective: To determine if a brief, automated telephone intervention using speech recognition (SR) technology improves ICS adherence among adults with asthma.
Methods: PEANUT is an ongoing randomized clinical trial involving 14,064 members of a health maintenance organization (HMO), aged >18 years, taking medication for the management of asthma. Participants receive usual care (UC) or an 18-month SR intervention. SR participants receive monthly refill reminder calls, as needed, based on dispensing data derived from the electronic medical record. The calls provide educational information, explore barriers to adherence, and offer transfer to an automated refill line as appropriate. The primary outcome is the continuous measure of medication adherence (CMA), a measure of medication days dispensed relative to total observation days. Preliminary data through the first 8 months are presented.
Results: Of over 10,000 calls attempted so far, we successfully reached the target participant 45% of the time and left a voice message on an additional 40% of calls. CMA scores are significantly higher for SR than UC participants (0.48 vs. 0.45, P<0.01), with the strongest effects (a five percentage point net differential) in those aged >60 yrs. One in 16 calls results in a direct transfer to the HMO’s automated prescription refill service.
Conclusion: Early results suggest a small, significant intervention effect. Because small changes in adherence on a population basis can have important public health benefits, this study supports the potential value of SR-based adherence interventions for asthma and other chronic diseases.
