Reminder letters to physicians caring for heart attack patients saved lives and cut costs

Aug 6 2004

Simply sending reminder letters to physicians caring for heart attack patients saved lives and cut costs by increasing use of a recommended but underused drug, according to a new study.

The drug, called a beta-blocker, should be prescribed for many patients who have suffered a heart attack, according to national evidence-based guidelines. Beta-blockers improve survival and lessen chances of second heart attacks.

The research appears in the American Journal of Managed Care.

Researchers from the University of Maryland, led by Ilene H. Zuckerman, Pharm.D., sent educational packages to the doctors of 2,543 Pennsylvania Medicaid patients. Package content varied slightly with each patient’s status. But the full package went to 485 doctors identified as having patients who should have been using beta-blockers but were not. Another 10,972 doctors received a newsletter containing much of the same information, but not tailored to specific patients.

The educational package included a letter about ways to treat heart attack patients, the problems patients had in obtaining and continuing to use beta-blockers, and ways to increase the use of these drugs. Doctors of patients who were not taking beta-blockers also received a list of the patients’ pharmacy records.

After the mailings, heart attack survivors were 16 percent more likely to be prescribed a beta-blocker, compared to patients before the intervention.

That effect may seem small, Zuckerman says, but it was statistically significant. Because the number of patients involved was so large, there were important benefits to even this one-shot intervention. Examination of pharmacy records also showed that the number of patients filling their prescriptions increased by 8.3 percent after the mailing, Zuckerman says.

The increased use of beta-blockers saved three lives, she estimates, and reduced hospitalization and other costs, saving more than $76,000 for the Pennsylvania Medicaid system. There was probably also a spillover effect to other patients and to doctors’ increased awareness of when to use beta-blockers.

“Materials were disseminated to many physicians in Pennsylvania,” she says, “and are likely to have some impact on care of heart attack patients well beyond the study population.”

http://www.cfah.org