Discussion
erectile dysfunction
ADVERSE EVENTS, SIDE EFFECT, ERECTILE DYSFUNCTION
We found that our AE-PRO data collection and response system significantly increased treatment continuation over the duration of the study period. Though we were unable to assess the impacts of side effect counseling templates through a controlled experiment, the significant, positive correlation between template use and treatment continuation suggests potential for improving patient care, and warrants further research.In cycle 1, the RxCI intervention led to an ultimate difference in treatment continuation of approximately four percentage points, compared to control (75% intervention group vs. 71% control group). This difference occurred regardless of whether patients in the intervention group fully engaged with the questionnaire (i.e. completed and returned it). It's possible that some patients in the intervention group who didn't return their questionnaires reached out to their providers directly. If this was the case, it implies that completing the questionnaire itself might not have been as critical as nudging patients to engage with their care. Given the technical infrastructure of the EHR data, we were unable to formally test this hypothesis but it remains an area for future research.We additionally found that the effect of the RxCI intervention and of medication adjustment each independently affected the likelihood that patients refilled their next prescription. The lack of a statistically significant intervention-by-medication-adjustment interaction term implied that administering the intervention did not appear to strengthen the association between medication adjustment and prescription refill. However, the positive association between medication adjustment and prescription refill (regardless of intervention assignment), combined with the higher likelihood of prescription refill in intervention group patients, together suggest that medication adjustment played a role in treatment continuation, and that the RxCI provided a helpful channel through which patients could request such adjustment. While there are no existing studies evaluating the impact of PROMs on treatment continuation for ED patients, this study’s results corroborate previous findings that integrating PRO tools into routine care can help healthcare organizations assess adverse events [The study’s primary limitations are 1) possible noise in the EHR data resulting from unlikely but plausible scenarios that would lead to measurement error, such as a prescription refill being the result of correcting an initial cancellation and not a true continuation of treatment, 2) the potential for nonresponse bias in the returning of the questionnaire, and 3) possible lack of generalizability beyond the specific telehealth platform and population in which the experiment was conducted. Limitations notwithstanding, we believe our findings provide a useful and illustrative starting point for other organizations seeking to implement similar AE-PRO collection and response systems. Though the study population consisted of patients receiving PDE-5 inhibitors, our findings may also apply more widely to medications that also require adjustment to achieve optimal efficacy and tolerability and thus greater medication adherence, but more research is needed to determine whether this is the case. Measuring treatment continuation in ED is challenging. Unlike life-sustaining medications for chronic conditions, most PDE-5 inhibitors are taken as needed, and prior research indicates that patient behavior as it relates to treatment continuation is subject to a number of factors, such as medication cost and the influence of sexual partners [For monitoring and maintaining any increase in rates of treatment continuation and side effect reporting, consistent audits will be conducted, and necessary process improvements will be implemented. Our findings are a promising start, but iterative processes that test variations of both intervention protocols and the intervention itself might result in a more dramatic effect; for example, increasing the number of prompts or testing across different delivery vehicles (e.g. via text instead of email). It is presumed that treatment continuation leads to optimal patient outcomes, but future research can include clinical and quality of life outcome measures to test this hypothesis. Nonetheless, interventions that center patient-reported outcomes and experiences have the potential to improve the quality of care for patients receiving virtual treatment for erectile dysfunction and possibly other conditions in which side effects play a role in treatment continuation.