Study shows multi-modal clinical support participation drives higher medication adherence for new patients
Driving medication adherence is a persistent challenge in specialty pharmacy. Often, patients are managing complex chronic conditions with high-cost therapies that require sophisticated, time-sensitive treatment plans.
Affordability isn’t the only barrier that can leave patients struggling to maintain adherence. Patients needing specialty medication may also be dealing with knowledge gaps, treatment fatigue or low motivation resulting from the ongoing burden of living with chronic illness.
Each year in the United States, medication nonadherence can account for:1
- 50% of treatment failures
- 125.000 deaths
- Up to 25% of hospitalizations
Clinical support via digital health tools and a patient-centered communication approach can have a positive impact on adherence and health outcomes.
Research goal
Recognizing the needs and opportunities for enhanced, comprehensive patient support, Accredo Specialty Pharmacy launched a clinical study to better understand the adherence impact of providing patients with multi-modal engagement opportunities for clinical support.
Multi-modal refers to the use of multiple communication and support channels to engage and assist patients. Specifically, this includes both telephonic support (such as regular calls from care coordinators or automated voice reminders) and digital support (such as mobile apps, text messages, or online portals). A multi-modal approach offers patients flexible, accessible, and personalized support across different platforms.
Study background
The study focused on the specialty drug dupilumab, a self-injectable biologic approved to treat asthma, atopic dermatitis, nasal polyps, eosinophilic esophagitis,prurigo nodularis, and, recently, COPD. Adherence can be complicated by factors like storage requirements, injection burden, side effects and prolonged treatment duration. The first several months of treatment are a critical period for adherence. Ensuring early consistency gives patients the best chance to experience symptom improvement. Optimized adherence makes it easier on prescribers to accurately assess treatment response at follow-up.
Study objective
Accredo’s study assessed whether providing more than one mode of clinical support could improve patient engagement and make a quantifiable impact on adherence. Patients studied had access to multiple medication management solutions. They could use telephonic (telephonic education and coaching), digital (a smart sharps device with a companion digital app) or both clinical support offerings.
The hypothesis: Driving higher engagement through multi-modal support programs would correlate with better medication adherence.
Research design and methodology: Observational cohort with lead-in enrollment methodology
The Accredo research team observed 14.552 adult patients (ages 18-89), who initiated dupilumab therapy between July 1 and December 31, 2023, and were eligible for Accredo’s multi-modal clinical support pilot program.
Researchers tracked engagement for the first six months of treatment to sort patients into three cohorts:
- Unengaged: No participation in either offering
- Moderately engaged: Participated in either digital or telephonic support
- Maximally engaged: Participated in both digital and telephonic support
After six months of treatment, adherence was measured. The results presented here are drawn from this six-month observation window. Adherence for each cohort was measured in Proportion of Days Covered (PDC), a calculation of the percentage of days a patient has medication on hand. A PDC of 80% or higher is typically considered optimally adherent.
Researchers used bivariate statistical tests to compare differences among cohorts and applied multivariable linear and logistic regression to control for demographic group differences, like age and gender mix.
Key findings: Multi-modal clinical support participation encourages medication adherence
Maximally engaged patients achieved (in comparison to unengaged patients):
- 9,4% higher average PDC
- 1.8x higher likelihood of achieving optimal adherence
Moderately engaged patients (in comparison to unengaged patients):
- 5,4% higher average PDC
- 1.4x higher likelihood of achieving optimal adherence
Patients taking dupilumab who participated in both clinical support modes (i.e. digital and telephonic) showed more improvement in adherence than those using only one offering. However, any level of clinical participation saw significant adherence improvement over those patients who never engaged.
The percentage of patients maintaining optimal adherence (a PDC ≥ 80%) during their first six months of treatment was also better for patients engaged in clinical programming, with 70% of maximally engaged patients and 64,3% of moderately engaged patients remaining above the optimally adherent threshold. Only 57,1% of patients unengaged in clinical programs remained optimally adherent at six months. The improvements in PDC for dupilumab patients when engaged in one or both clinical support offerings suggests that multi-modal clinical support strategies can meaningfully improve adherence outcomes.
The role of multi-modal support strategies in specialty adherence
This research demonstrates that providing accessible tools for clinical patient support — and especially leveraging combined strategies like telephonic and digital modes of communication — leads to stronger medication adherence.
Multi-modal support that leverages both technology and empathetic human interaction is key to effective, scalable improvements in adherence. Accredo’s use of robust multi-modal clinical support offerings represents a path toward improving care and maximizing adherence for patients.
Key takeaways
Accredo’s findings signal to prescribers, patients, and other specialty pharmacy partners, the value of multi-faceted adherence programs. Stakeholders should prioritize partnerships with specialty pharmacies that offer a variety of clinical support modalities accessible to diverse patient populations. When patients are supported through multiple channels, they’re more likely to stay on therapy and feel cared for along the way.
Partnering with a specialty pharmacy that is actively testing and refining its clinical model to improve patient adherence offers substantial value to patients and business partners. This continuous innovation leads to better health outcomes by ensuring patients consistently take their medications as prescribed, particularly for complex or high-cost conditions.
Specialty pharmacies, like Accredo, are uniquely positioned to help patients succeed in their therapeutic journeys. Our multi-modal clinical support offerings meet patients where they are to drive better engagement and improve adherence.
Learn more about Accredo’s clinical research posters and other studies.
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Kim, J. Medication Adherence: The Elephant in the Room. U.S. Pharmacist. Published January 19, 2018. Accessed February 8, 2025. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room
