Estimating the Impact of a Congestive Heart Failure Disease Management Program on Prescription Drug Use

Abstract

Background and Objective: Evaluations of the disease management (DM) programs for commercial health plans are widely published. However, publications of DM-program outcomes for the more at-risk Medicaid population are rare. This study evaluates the impact of DM efforts in a Medicaid congestive heart failure (CHF) program. The objective of this study is to use propensity score methods to evaluate the impact of CHF DM efforts on compliance to evidence-based guideline pharmacy drug use in a US Northwestern state Medicaid program. Methods: Two retrospective observational methods using propensity scores are considered: propensity-score matching and covariate adjustment by the propensity score. Data were collected between October 2000 and May 2005 for members of the Medicaid program who were eligible for the study. The DM intervention group included Medicaid participants identified with CHF and not enrolled in any other DM program prior to participating in the CHF DM program. The control group included Medicaid participants identified with CHF who could not be contacted for enrollment or chose not to participate in the program. A total of 162 matched-pairs were included in the propensity score matched analysis, while 250 DM intervention group participants and 232 controls were included in the covariate adjustment analysis. The main outcome measures were total number of pharmacy prescriptions, proportion of patients using ACE inhibitors, and proportion of patients using β-adrenoceptor antagonists. Results: In both propensity score methods, the total number of pharmacy prescriptions and ACE inhibitor use were statistically significantly higher in the DM intervention group compared with the control group during the program period, with DM participants having 25% more total pharmacy prescriptions and a 20% higher rate of ACE inhibitor use. Conclusions: This analysis suggests that CHF DM programs can result in increased compliance to evidence-based guideline prescription drug use. The results of this study support the need for randomized controlled trials of DM programs to validate the positive pharmaceutical compliance results found in this study, and further to evaluate whether DM programs can reduce the use of medical services and cost of care while improving health status.