The researchers started their investigation with the understanding that funding for intervention in this area is limited and it would therefore be helpful to know which types of patients would be most responsive to their efforts. They began with 6000 patients over 18 who had Type 2 diabetes and who were enrolled with a health insurance group in New Jersey. They divided the patients into three groups: low-intensity intervention, moderate-intensity intervention and high-intensity Intervention. The low-intensity group had a telephone consultation with a pharmacist and two follow-up calls. The second group got as many as six follow-up calls and two calls with a physician or a pharmacist, or both. The third group had as many as 12 follow-up calls and as many consultations with physicians and pharmacists as seemed necessary.
In the area of helping patients stay on their insulin, there were no significant differences among the three groups — increasing the intensity of the intervention didn’t raise the chances the patients would continue to fill their prescriptions. However, greater improvements in control of blood glucose were reported in the high-intensity group. As the authors reported, “a highly targeted high-intensity intervention improved glycemic control by a statistically significant amount…. The improvements were roughly equivalent to those anticipated from the addition of an oral hypoglycemic medication.”
Based on their findings, the researchers concluded that, considering the limited amount of resources, it might be best to concentrate on certain patients. As they wrote, “Targeting a different patient population might have increased the effectiveness of the interventions that we tested. For example, we focused on patients at moderate risk of nonpersistence. It is possible that the intervention could have been more effective if targeted to patients at highest risk rather than those who we hypothesized would be more impactable.” According to the authors, “Given that more intensive interventions tend to result in larger improvements in adherence, focusing only on individuals most likely to benefit may allow more resources to be devoted to fewer individuals without increasing overall costs of an intervention program.”
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