Use of Automated Phone Calls to Promote Adherence with Inhaled Corticosteroids

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DESCRIPTION (provided by applicant): The failure of patients to adhere to physician-prescribed chronic medication regimens has been well- documented in the medical literature. Poor adherence has been demonstrated across a wide range of chronic conditions, including hypertension, asthma, and congestive heart failure. The clinical implications of this non-adherence can include treatment failure, unnecessary and dangerous intensification of therapy, hospitalizations, and deaths. A recent report of the World Health Organization concluded that therapy non- adherence contributes substantially to disease morbidity, reduced quality of life, and increased health care utilization. The objective of this research is to test the effectiveness of conducting telephone outreach using speech recognition (SR) software to improve adherence to inhaled corticosteroids (ICS) among members of a large health maintenance organization with asthma or chronic obstructive pulmonary disease (COPD). The primary outcomes will be the continuous measure of medication acquisition and the continuous measure of medication gaps. Secondary outcome measures include self-assessed patterns of medication use, disease- specific health status, satisfaction with care, use of hospital-based services for asthma/COPD, and total cost of acute care for asthma/COPD. This randomized clinical trial would enroll the estimated 24,500 members of the Kaiser Permanente Northwest and Hawaii regions aged 18 years or older who will have been seen for asthma or COPD and received at least one dispensing of a breathing medication during the year prior to randomization. Participants will be randomized at the patient level to receive either usual care or an SR-based intervention designed to promote improved adherence to ICS medications. Randomization will occur after an initial 14- month development phase during which the intervention scripts are developed, piloted, and finalized. The intervention will continue for one year post randomization. Relevance: The goal of this research is to test speech recognition software for telephone calls to improve how patients take medications for asthma and long-term lung disease. This method, if it helps people take their medications as prescribed, could be used with a variety of other long-term medical conditions.