Medication Compliance Reduces A1c by 1.4%

Pharmacy pilot program demonstrates importance of taking medications according to nationally established clinical guidelines. Just a simple program of monitoring medication compliance can have a major impact on the patient’s quality of life.

Because the pilot program was so successful, the Diabetes Outcome Improvement Program has now been implemented nationwide. In addition to monitoring glucose levels, members in the national program who have high blood pressure, low kidney function or high cholesterol are monitored for medication compliance for those conditions as well.

Members in the pilot program for whom CPM could document a blood glucose level reduction were able to reduce their HbA1c blood glucose level by 1.4 percent on average. According to the United Kingdom Prospective Diabetes Study (UKPDS), the largest and longest study of type 2 diabetes performed to date, each one percent reduction in blood glucose level may reduce the risk of complications such as kidney failure, heart attack, blindness or amputation by 35 percent.

"A 1.4 percent reduction could correlate to as much as a 49 percent decrease in the risk of related complications. In addition, we found that 69 percent of the individuals identified in our program were being treated for one of the complications related to their diabetes.

In the pilot program, medical, pharmacy and lab claims data was used to identify members who were not reaching recommended long-term blood glucose levels. CPM then reviewed medication utilization patterns to determine if that might be contributing to higher than desirable blood glucose levels. The presence of more than one related illness including hypertension, kidney disease, or high cholesterol was also identified. The physicians for the members participating in the pilot were then sent information on each member, including lab data, medication utilization and hospital or emergency room visits, as well as recommended treatment goals for the member. The physicians were encouraged to review the information and consider whether adding or changing therapy would help the member achieve treatment goals. Members were re-evaluated every six months. The importance of reaching or progressing towards treatment goals was stressed at each subsequent contact with the members’ physicians.

The CPM provider-focused diabetes program complements the CIGNA Well Aware for Better Health(R) diabetes disease management program which provides members with self-care information and support from a nurse coach to help them better manage their condition. The pharmacy management program included physician outreach for members enrolled in the Well Aware program as well as those who were not.

JAMA. 2003, Oct 8;290(14):1884-90, K.M. Venkat Narayan, MD, CDC Chief of Diabetes Epidemiology.

Editors Note: By checking with the patients pharmacist to see if the patient is taking their medications, can have a major impact on their quality of life.

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