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In this evaluation, four versions of emails will be sent to eligible health plan members who are not currently enrolled in the health system's mail-order pharmacy. A control group will not receive any communication. The researchers hypothesize that the use of content informed by behavioral nudge theory in the emails should lead to increased enrollment in the health system's mail-order pharmacy.
The utilization of a mail-order pharmacy can increase adherence to medications. The health system's mail-order pharmacy (from here, simply referred to as mail-order pharmacy) can also provide reduced costs for medications. Ongoing outreach efforts involve sending emails and other communications encouraging enrollment in Geisinger's mail-order pharmacy to eligible members of the system's health plan (i.e., those who take maintenance medications). The study will compare a standard promotional email from these outreach efforts, as well as three new emails with content informed by behavioral science research, against a no-contact control arm and each other.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Email | Active Comparator | The "standard of care" email is the same as one used in prior outreach efforts at the health system, emphasizing reduced cost for medications and convenience. |
|
| Email with Healthcare Cost Savings | Experimental | The email emphasizes future reductions in healthcare costs due to increased adherence with mail-order pharmacy, in addition to mentioning reduced prices for medications. It also uses fear appeals by stating the risk of hospital stays and how mail-order pharmacy could be an easily-achievable way to avoid this negative consequence. |
|
| Email with Endorsement | Experimental | The email is a letter from a doctor at the health system's health plan--who may been seen as a trusted source of information--encouraging the benefits of using a mail-order pharmacy. |
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| Email with Comparison Table | Experimental | The email includes a table comparing the benefits and drawbacks of mail-order and chain pharmacies, which appeals to their sense of agency and allows them to make the choice that best suits them. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fear Appeals | Behavioral |
| ||
| Measure | Description | Time Frame |
|---|---|---|
| Mail-order Pharmacy Enrollment | Binary variable indicating if there was an enrollment in the health system's mail order pharmacy | 1 week from the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Email Opens | Binary variable indicating if the email was opened | 1 week from the intervention |
| Email Link Click | Binary variable indicating if the link to the mail-order pharmacy website was clicked |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geisinger | Danville | Pennsylvania | 17822 | United States |
Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
The data on the Open Science Framework will be open to anyone requesting that information.
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| ID | Term |
|---|---|
| D010342 | Patient Acceptance of Health Care |
| D003142 | Communication |
| D001519 | Behavior |
| ID | Term |
|---|---|
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
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1 x 5 design
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Participants and providers are not aware that different mailer versions exist, and they do not know what elements in the letter are being tested.
| No Contact | No Intervention | Members do not receive an email. |
| Message about Future Healthcare Costs |
| Behavioral |
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| Endorsement from a Doctor | Behavioral |
|
| Comparison Table | Behavioral |
|
| Highlighting Cost Savings and Convenience | Behavioral |
|
| 1 week from the intervention |
| Email Unsubscribes | Binary variable indicating if the recipient requested to unsubscribe from receiving emails from the health system | 1 week from the intervention |