Bundling Cardiovascular and Diabetes Medications Reduces Mortality Risk

The American Heart Association and American Diabetes Association evidence-based guidelines recommend prescribing statins and angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) for patients with cardiovascular disease (CVD) and diabetes to improve clinical outcomes and reduce mortality; however, many patients are not taking this medication bundle. In a study, researchers found that increasing the prescribing of the cardio-protective medication bundle improved CVD outcomes and lowered mortality in this patient population. The results of the study were presented during AMCP eLearning Days in a poster presentation titled “Impact of a Prescriber Call Program in Promoting the Prescribing of the Cardio-Protective Medication Bundle.”

The study included 8,739 Medicare (MAPD and MMP) and commercial health plan patients in California with diabetes and/or CVD who had no previous statin prescription fill. Of these patients, 3,756 also had no prescription fills of an ACEi or ARB.

All physicians received a letter via fax or mail encouraging the prescribing of the cardio-protective medication bundle. Physicians of MAPD patients (n=4,795) received phone calls, while physicians of commercial and MMP patients (n=3,944) received only a letter.

A team of pharmacists and technicians called physician offices to illicit a response. Technicians ensured provider offices received the letters, while pharmacists engaged in a clinical conversation with providers or their staff. To determine the success of the program, researchers assessed pharmacy claims data post-intervention.

About 10 months after the phone calls, 33% of patients (n=1,600) in the call group were started on a statin compared with 21% (n=845) in the letter only group (P<0.00001). In addition, 15% of patients (n=282) in the call group were started on an ACEi or ARB compared with 11% (n=196) in the letter only group (P=0.00609). There was a 60% decline in per-member, per-month costs due to reduced utilization related to CVD events.

“Managed care organizations should employ prescriber outreach call programs to achieve higher rates of prescribing. There is a statistically significant difference between a call program and a letter program in accomplishing this goal,” the researchers concluded.

The study was sponsored by Envolve Pharmacy Solutions.

Jaghasspanian T, Nguyen H. Impact of a Prescriber Call Program in Promoting the Prescribing of the Cardio-Protective Medication Bundle. Abstract E7. Presented during AMCP eLearning Days, April 20-24.