Abstract
Background
Patient support programs (PSPs), including medication management and counseling, have the potential to improve care in chronic disease states with complex therapies. Little is known about the program’s effects on improving clinical, adherence, humanistic, and cost outcomes.
Purpose
To conduct a targeted review describing medical conditions in which PSPs have been implemented; support delivery components (eg, face-to-face, phone, mail, and internet); and outcomes associated with implementation.
Data sources
MEDLINE – 10 years through March 2015 with supplemental handsearching of reference lists.
Study selection
English-language trials and observational studies of PSPs providing at minimum, counseling for medication management, measurement of ≥1 clinical outcome, and a 3-month follow-up period during which outcomes were measured.
Data extraction
Program characteristics and related clinical, adherence, humanistic, and cost outcomes were abstracted. Study quality and the overall strength of evidence were reviewed using standard criteria.
Data synthesis
Of 2,239 citations, 64 studies met inclusion criteria. All targeted chronic disease processes and the majority (48 [75%]) of programs offered in-clinic, face-to-face support. All but 9 (14.1%) were overseen by allied health care professionals (eg, nurses, pharmacists, paraprofessionals). Forty-one (64.1%) reported at least one significantly positive clinical outcome. The most frequent clinical outcome impacted was adherence, where 27 of 41 (66%) reported a positive outcome. Of 42 studies measuring humanistic outcomes (eg, quality of life, functional status), 27 (64%) reported significantly positive outcomes. Only 15 (23.4%) programs reported cost or utilization-related outcomes, and, of these, 12 reported positive impacts.
Conclusion
The preponderance of evidence suggests a positive impact of PSPs on adherence, clinical and humanistic outcomes. Although less often measured, health care utilization and costs are also reduced following PSP implementation. Further research is needed to better quantify which support programs, delivery methods, and components offer the greatest value for any particular medical condition.
Acknowledgments
The authors acknowledge the valuable role of Dr Margaret Yung (EPI-Q Inc.) and Lillian Bellf i (University of Illinois-Chicago, College of Pharmacy) in screening citations, abstracting data, and editing the manuscript.
Disclosure
Arijit Ganguli and Jerry Clewell are employees (and shareholders) of AbbVie Inc. Alicia Shillington is an employee and shareholder of EPI-Q Inc. This systematic review and manuscript development was funded by AbbVie, Inc. The design, study conduct, and financial support for the study/trial were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the poster; all authors contributed to the development of the publication and maintained control over the final content. The authors report no other conflicts of interest in this work.