Trajectory Modeling On Adherence By CVS

No one who works with consumers or who studies adherence should too surprised that people are different in how they fill their medications. I think companies are finally getting a better handle on longitudinal member records and ways of studying those patterns to determine how and when to intervene.

Our past behavior is always a great place to learn from about our future behavior but at the same time, people view different drugs and conditions differently. For example, I might be very likely to take my pain medication everyday since it’s a symptomatic condition versus my cholesterol medication since it’s an asymptotic condition. I also may take a different approach yo medications that have significant side effects.

At the same time, these data is well known so the quest for the “best” segmentation approach and behavior change model continues.

With that in mind, I finally got a chance to look at some research from September that researchers at CVS Caremark and Brigham and Women’s Hospital published in the journal Medical Care. They used trajectory modeling to follow statin users for 15 months and came up with six groups:

• Brief gap in medication use or filled irregularly during the first nine months, but improved during the last six months (11.4 percent)
• Slowly declining adherence throughout the 15 month period (11.3 percent)
• Used statins only occasionally across the 15 month study period (15 percent)
• Rapid decline in statin use after initiation (19.3 percent)
• Virtually no fills after their initial fill (23.4 percent

They also identified some characteristics associated with adherence:

• Higher adherence was seen with patients who were older, had higher incomes and held a high school diploma.
• The highest adherence rates were associated with Medicare Part D clients and people who live in New England.
• Those with the lowest adherence rates tended to be generally younger, male and less likely to have an initial prescription that provided them with more than a 30-day supply of medication.

Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark:

“The use of trajectory models could help us more accurately identify patients at risk for medication nonadherence so we can develop and implement targeted interventions to help them stay on their medications for chronic health conditions.”