New analysis of Kaiser Permanente randomized clinical trial finds no age disparity in response to simple, automated refill reminders
Digital reminders sent to adults who did not consistently refill their statin prescriptions improved reorder rates for patients across a wide spectrum of ages, a new Kaiser Permanente study found.
The research was presented as a Late Breaking Clinical Trial at the American Heart Association Scientific Sessions annual meeting and simultaneously published in JACC. The results enhance the large study the investigators reported earlier this year that showed digital refill reminders — sent by text, through a patient portal, or by email — improved refill rates.
The digital reminder tested in the randomized trial was a new communication sent to patients who had not filled their prescriptions within 2 weeks of receiving the routine pharmacy reminder. The digital message told patients it was time to refill their statin, explained why the medication was important, and provided information on how to refill it.
“It is encouraging that simple, automated digital messages can help patients refill their statin medications, and that we did not see a clear decline in their effectiveness with increasing age,” said lead author Baiyang Sun, PhD, MPH, a statistical programmer analyst at the Kaiser Permanente Division of Research (DOR). “By using communication tools already built into health care systems, this approach offers a practical and scalable way to help patients stay on track with important preventive medications.”
Statins are prescribed to millions of people in the U.S. who have high cholesterol, type 2 diabetes, and other heart problems. Although studies have shown these drugs reduce the risk of heart disease, heart attack, and stroke, many people prescribed these medications do not consistently refill their prescriptions.
The study included a total of 20,604 adult members of Kaiser Permanente Northern California with a statin prescription. All the patients had been diagnosed with atherosclerotic cardiovascular disease (ASCVD) — meaning they had cholesterol deposits, called plaque, in their arteries — or had type 2 diabetes, which increases the risk for ASCVD. They also all had low adherence. This meant they filled their daily statin medication less than 80% of the time in the prior 12 months.
Among these adults, about 13% (2,792) were age 18 to 45; 75% (15,348) were age 45 to 64; and 12% (2,464 were age 65 or older. Within this older group, there were 789 adults age 70 to 75.
The study found that, overall, older age was associated with higher 14-day statin refills and the relative response to digital nudges was generally similar to that of younger adults. The study also showed refill rates were about the same for the 3 methods used to send the additional message — text, email, or patient portal.
“Older adults are sometimes assumed to be less responsive to digital communication,” said Sun. “But our findings suggest that age alone should not be a reason to overlook them when offering digital outreach. For patients who have access to these communication channels, simple reminders may be helpful across a wide range of ages. At the same time, making sure patients can access these tools remains an important consideration.”
The researchers noted that while text messaging is often perceived as preferred — or more widely used — by younger people, adults 65 and older were equally as likely as younger adults to refill their prescription after receiving the text reminder.
“Evaluating the equity and reach of implementation initiatives is essential to ensuring that effective interventions reach the patients who stand to benefit most,” said senior author Ankeet Bhatt, MD, MBA, ScM, a DOR research scientist and a cardiologist with The Permanente Medical Group. “This project demonstrates how we can prospectively evaluate not only whether an intervention works, but whom it reaches, while identifying opportunities to empower our members to be active participants in their own care.”
The study was funded by The Permanente Medical Group.
Co-authors include Vincent X. Liu, MD, MS, Ben J. Marafino, PhD, Mirasol Apostol-Largeteau, MPH, Andrew P. Ambrosy, MD, MPH, Alan S. Go, MD, of the Division of Research; Howard H. Dinh, MD, Gopi Manthripragada, MD, Ivy A. Ku, MD, MAS, Kevin Yee, MD, Kristine L. Lee, MD, and Mehreen Khan, MD, MPH, of The Permanente Medical Group; Lucy Finn, MPH, Payton Watt, MPH, Josephine Au, BS, Jaya Nadella, BS, Noreen Jesani, MPH, Jean C. Digitale, PhD, MPH, RN, Marilena Newberry, MHA, and Gurjot Kaur, MHA, of Kaiser Permanente Northern California; Tor Biering-Sorenson, MD, PhD, MPH, of Copenhagen University Hospital, Brian L. Claggett, PhD, Scott D. Solomon, MD, and Muthiah Vaduganathan, MD, MPH, of Harvard Medical School, on behalf of the ADHERE-ASCVD Investigators.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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