Educational Support Can Improve Compliance to Oral PAH Therapies

An educational nursing program can positively impact medication compliance in patients receiving oral pulmonary arterial hypertension (PAH) therapies, according to research presented at AMCP 2021, the annual meeting of the Academy of Managed Care Pharmacy, held virtually April 12-16.

PAH therapies do not reverse, halt, or cure the chronic disease. Instead, they improve pulmonary hemodynamics and offer symptom relief. However, because medication tolerance and compliance are a challenge, health care providers can play a role in improving adherence.

“In-home nurse visits offer disease state education, discuss therapy expectations, and provide support tools for patients when experiencing adverse events that might lead to therapy discontinuation,” the researchers explained.

They evaluated the impact of in-home or face-to-face education visits on oral PAH therapy compliance by comparing patients who were supported by a nursing program with patients who were not.

The researchers used CVS Health pharmacy claims to identify 2 groups: the study group was patients (n = 197) on riociguat, selexipag, or treprostinil who were supported by a nursing program and the control group was patients (n = 213) on bosentan, ambrisentan, or macitentan who were not supported by a nursing program. All therapies were oral PAH therapies and the study claims covered January 2018 to June 2019.

The study compared the following between the 2 groups:

• Fill count, or the total number of days covered by medication out of 30 days
• Medication possession ratio (MPR), which was the sum of the days’ supply of medication out of 180 days
• First fill drop off rate (FFDR), which was the percent of patients with only 1 fill during the study
• Therapy persistence, or the length of time a patient has the medication on hand

The study accounted for demographic and medication factors associated with adherence using a generalized linear model and logistic regression.

After 6 months, the study found patients in the study group:

1. Had a higher fill count: 5.1 vs 4.5 (P < .01)
2. Had a higher MPR: 86.4% vs 75.0% (P < .01)
3. Had a lower FFDR: 2.7% vs 5.7% (P = .14)
4. Had higher rates of therapy persistence: 72.0% vs 60.6% (P < .05)

Patients in the control group were 1.5 times more likely to drop their therapy in the first 6 months.

According to the authors, the significant improvement in MPR and therapy persistence highlighted the success of the educational nursing program in improving overall medication compliance to oral PAH therapies.

“While our study compared two different PAH therapy classes, a multidisciplinary patient support approach contributed to improved patient outcomes,” the authors concluded.

References

Sourounis E, Kyrychenko P, Avalos-Reyes E, Bagford D, Grover R, Feczko L. Effects of face-to-face educational nursing support on patient compliance with oral PAH therapies. Presented at: AMCP 2021; April 12-16, 2021. Abstract I6.