Prescription decision support fails to curb patient costs, boost med adherence

A clinical decision support system aimed at helping providers prescribe the drug least expensive to the patient failed to significantly reduce patients costs or improve medication adherence.

The study, published at Biomed Central, scrutinized the e-prescribing habits of 297 primary care physicians using formulary decision support (FDS). It focused on two types of medication: angiotensin receptor blockers and inhaled steroids, which did not have generic alternatives during the study period. That left choices with only subtle clinical differences.

Based on previous research showing that patients were more likely to fill and take prescriptions with lower co-pays, the authors expected software that showed doctors lower-cost alternatives would improve adherence.

The study examined non-interruptive vs. interruptive FDS. In the former, a symbol merely noted the availability of an alternative; the interruptive FDS automatically displayed a message suggesting the provider consider specific alternatives.

The interruptive FDS proved more likely to influence doctors' decisions, prompting the authors to conclude that FDS can be useful in helping physicians to choose preferred brands. However, the price differences among the medications were minimal, which did not save patients much money. It did not significantly improve adherence.

A recent study in the Annals of Internal Medicine found that nearly one-third of first-time prescriptions go unfilled and drugs in the upper quartile of cost were most likely to go unfilled.

And digital tools are being eyed as a way to improve adherence among medically complex, low-income patients who have trouble keeping up with their complicated regimens, according to a blog post at Health Affairs.

In addition, text messaging improved adherence among Medicaid patients by 12 percent during a clinical trial at New York-based Montefiore Medical Center's University Behavioral Associates.

To learn more:
- read the study(.pdf)