Pharmaceuticals remain the most cost-effective modality known to modern medical science.(1) Prescription therapy can greatly shorten or eliminate the need for hospitalization and occasionally eliminate the need for surgery.(2,3) However the medical literature provides ample evidence to suggest that compliance with prescribed therapy remains a major public health care concern.(4,5) Studies document that compliance with therapeutic regimens for chronic disease states is often <50%.(6,7) Furthermore, noncompliance has been associated with an increase in hospital admissions, length of stay, and related health care expenditures.(3)
Hypertension is a silent disease process, the full seriousness of which becomes evident to patients only when the sequelae of long-standing high blood pressure (BP) are manifested as congestive heart failure, angina, myocardial infarction, stroke, and end-stage renal disease.(9-12) Thus, it is often difficult to persuade patients that BP control is important to their continued well-being. (13-15) As a result, a significant percentage of diagnosed hypertensive patients. discontinue their prescribed regimen.(16-18)
As previously reported by Sclar et al, a multifactorial health education program designed to enhance the appropriate utilization of a once-daily regimen of atenolol (Tenormin(R), ICI Pharmaceuticals, Inc) was evaluated among 985 patients enrolled in health maintenance organizations (HMOs).(19) The initiation of the 360-day study period was used to classify patients as either new or existing cases of hypertension. In turn, patients within each category were randomly assigned to a control or experimental group. Patients assigned to experimental groups received an enrollment kit upon exercising their initial prescription (new-hypertension patients) or first refill request (existing-hypertension patients). The kit contained a 30-day supply of atenolol, an educational newsletter designed specifically for hypertensive patients, information on nutrition and life-style change, and written materials detailing the intent and content of the program. Before the next scheduled prescription-refill date, each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of regimen adherence. For 5 months thereafter, the newsletter and an enclosed prescription-refill reminder were mailed to each patient, along with samples and coupons for health-related items.*
The Medication Possession Ratio, defined as the number of days supply of atenolol obtained by a patient during the 360-day study period, was significantly (P <=0.001) enhanced for the new-and existing-hypertension experimental groups relative to controls. Multiple regression analyses revealed that enrollment in the health education, program increased the days supply of atenolol obtained by existing-hypertension patients by 61 (P <=0.001) and by 72 among new-hypertension patients (P <=0.001) over the 360-day study period.
The present study was designed to discern the effect of the health education program on service substitution in the HMO environment.
METHODS AND STATISTICAL APPROACH
The study population consisted of 985 ambulatory staff model HMO enrollees from California, Delaware, Massachusetts, New York, Ohio, Texas, and Wisconsin (Table 1). (Table 1 omitted) Patients were diagnosed as having mild to moderate hypertension and prescribed a once-daily regimen of atenolol. The initial date of the 360-day study period was used to classify patients as having either new or existing cases of hypertension. The categories for analysis were specified as follows:
* New case: a person diagnosed with hypertension after initiation of the study period, prescribed a once-daily regimen of atenolol as monotherapy for hypertension, and completing a 12-month enrollment period
* Existing case: a person diagnosed with hypertension before the initiation of the study period, prescribed a once-daily regimen of atenolol as monotherapy for hypertension, and completing a 12-month enrollment period. …