New, large-scale study shows improved medication adherence using Accredo’s double-pronged approach
Medication adherence is a critical factor to achieving positive health outcomes, particularly for patients managing complex conditions with specialty medications. However, even after addressing common barriers to adherence such as clinical support and financial help, many patients still struggle. This is oftentimes due to less noticeable motivational factors, such as coping with treatment fatigue, or the added burden chronic illness brings to the daily grind for patients and caregivers.
Accredo by Evernorth wanted to understand how to better address individual barriers to specialty medication adherence in an at-risk patient population. To do so, the clinical research team implemented a motivational interviewing program layered on top of its already robust Therapeutic Resource Center® model. The findings of this research were accepted for presentation at the Academy of Managed Care Pharmacy’s (AMCP) NEXUS meeting in October 2024.
This article is a summary of the research and its key insights, with a particular focus on motivational interviewing and its impact on the results.
What is motivational interviewing?
Motivational interviewing (MI) was developed in the early 1980’s to support patients with substance abuse. Since that time, robust evidence has shown the benefit of MI translated for use in health care, education, training in the workplace and government agencies, among others.
One purpose for using MI in health care is to help improve medication adherence. Unlike traditional adherence interventions that often rely on reminders and didactic education, MI focuses on identifying and enhancing the patient's internal motivation to change. This is done through exploring their own reasons for adherence and building confidence in managing their health.
As part of Accredo’s Adherence Course Correct intervention, specialty clinicians trained in MI used it to help at-risk patients explore and resolve ambivalence towards their medication taking behaviors. In this research, the Accredo team looked to evaluate the impact and efficacy of MI in a telephonic, specialty pharmacy context across a diverse range of therapeutic areas.
Research design: Large-scale study on at-risk specialty patient population
This research holds particular significance because it is one of the largest populations evaluated to find the impact of MI medication adherence, and one of the few focused on specialty drugs. Using the broad patient base of Accredo, the team sampled nearly 41.000 patients (about twice the seating capacity of Madison Square Garden) from across over three hundred therapeutic areas.
The method of analysis used to assess the effectiveness of the intervention was a proactive, case-control cohort. This means that patient behavior among at-risk individuals was observed and measured over time and compared between groups who were identical except for their participation in MI.
Patients were targeted for intervention using a proprietary behavioral trend algorithm which identified those most at-risk for worsening adherence.
- The patients were placed into one of three groups based on whether MI was added to their existing support:
- Completed MI Intervention
- Attempted intervention with messaging
- Control (no intervention)
- The design focused on empowering patients to take ownership of their health behaviors to address personal barriers to adherence.
- The patients had baseline six-month adherence averaging between 61-63%, measured using Proportion of Days Covered (PDC).
Key findings: Positive impact on specialty medication adherence
The results gathered from our study show a significant improvement in adherence for the MI intervention group when compared with the control group. This shows that the MI-assisted approach was successful at increasing adherence in the at-risk population sampled.
The primary outcome measured was a six-month adherence change in each group as Proportion of Days Covered (PDC). A target PDC of 80% or higher is the typical standard for considering a patient adherent to therapy. Adherence was looked at both six months before and after the MI intervention occurred.
- Completed MI intervention group PDC increased to 68%
- Control group PDC declined to 50%
- Attempted intervention with messaging group PDC declined to 55%
Importantly, the study also found that successful MI interventions resulted in a 17% increase in the number of patients achieving the optimal adherence threshold of 80% PDC when compared with the control group.
The value of a robust specialty pharmacy offering
This research proves that MI can improve medication adherence across a wide range of specialty therapeutic areas. By focusing on patient-centered interventions and using the expertise of a hyper-specialized clinical staff in its TRC model, Accredo successfully improved adherence rates for patients identified at-risk for non-adherence.
For healthcare prescribers and pharmaceutical manufacturers, this study highlights the value of working with a specialty pharmacy that uses highly skilled clinicians and behavioral-risk stratification paired with evidence-based solutions, like motivational interviewing, to manage complex specialty conditions. Accredo’s TRC practice model layered with our custom MI approach, provides a scalable, effective solution for enhancing adherence and improving the overall quality of care.
Access all Accredo’s clinical research posters here: Specialty Clinical Research
