Evaluating Ways to Improve Medication Use Among People With Osteoporosis

Mass General Brigham

Status and phase: Completed; Phase 3

Conditions: Osteoporosis

Treatments: Behavioral: Telephone coaching program for patients; Behavioral: Medication adherence alert program for doctors; Behavioral: Mailed education

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00567294

P60AR047782-06A1 (U.S. NIH Grant/Contract)

P60AR047782 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

Osteoporosis is a common bone disease in older adults in which the bones become weaker and prone to fracture. Medications are available to slow or even stop disease progression. However, very few adults who are prescribed osteoporosis medications actually follow through with filling their prescriptions and taking the medications. Ways to improve medication use have not been well developed or adequately tested. The purpose of this study is to evaluate a telephone coaching program, with or without helpful adherence notifications to doctors, in improving treatment adherence in older adults who are starting an osteoporosis medication.

Full description

Fractures associated with osteoporosis are expected to rise to 3 million by 2025 with a cost of $25 billion in medical costs. Many of these fractures could be avoided through preventive measures, such as improved implementation of fall reduction strategies and use of effective medications. While medications can significantly reduce the chance of fractures among adults with osteoporosis, alarmingly few at-risk adults use osteoporosis treatments regularly. Only 10% to 30% of at-risk adults ever initiate osteoporosis medications, and of those, only 40% to 50% continue to fill their prescriptions after 1 year. There is a clear need to develop ways for improving adherence with osteoporosis medication regimens. The purpose of this study is to evaluate a telephone coaching program, with or without helpful adherence notifications to doctors, in improving treatment adherence in older adults who are starting an osteoporosis medication.

Participation in this study will last 1 year. Through random assignment of doctor practices, participants will fall into one of three groups.

• Group A participants will receive mailed education materials on osteoporosis and medication use throughout the 1-year study.
• Group B participants will receive monthly 5- to 10-minute phone calls from a health educator who is specially trained in osteoporosis. The phone calls will involve coaching participants on behavioral reinforcement strategies that will help them to continue taking their medications on schedule. Participants will also receive specially tailored education on osteoporosis and fracture prevention during the phone calls. A close family member or friend of the participant will be contacted via phone two times during the study year. During these phone calls, the family member or friend will learn how to support the participant in such a way that medication adherence is more likely.
• Group C participants will receive the same treatment as Group B. Doctors assigned to Group C will receive written educational information on the rates of medication adherence, implications of nonadherence, and methods for improving adherence among patients. Doctors will also receive alerts about any of their participating patients who are not filling medication prescriptions. The alert message will be provided in both paper and electronic format. The electronic format can be easily formatted, allowing the doctor to send a personalized letter to their patients.

At the end of the study, all participants will complete a mailed questionnaire on their behaviors and demographics. Doctors will complete a mailed questionnaire aimed at determining what parts of the interventions were well received. The occurrence of hip, forearm, and/or upper arm fractures will be evaluated using Medicare claims data.

Enrollment: 2,087 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients enrolled in the Pharmaceutical Assistance Contract for the Elderly (PACE) program at the Pennsylvania Department of Aging who begin taking a medication for osteoporosis

Exclusion criteria

• Unable to communicate over the telephone with health educators

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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2,087 participants in 3 patient groups

A

Active Comparator group

Description:

Participants will receive mailed education materials on osteoporosis and medication use.

Treatment:

Behavioral: Mailed education

B

Experimental group

Description:

Participants will receive a telephone coaching program.

Treatment:

Behavioral: Telephone coaching program for patients

C

Experimental group

Description:

Participants will receive a telephone coaching program, and doctors of these participants will receive medication adherence alert notifications.

Treatment:

Behavioral: Telephone coaching program for patients

Behavioral: Medication adherence alert program for doctors