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August 13, 2014
PA Study Emphasizes Pharmacist Value in Improving Medication Adherence

Pittsburgh—Pharmacists can make a significant difference in medication adherence by asking just a few concise questions about how regularly patients take their drugs and initiating a brief discussion if screening scores indicate they are at risk of not sticking to their regimens.

That’s according to a new study led by researchers at the University of Pittsburgh School of Pharmacy and reported in the journal Health Affairs. The report points out that increased medication adherence can reduce emergency department visits and hospital admissions and lower healthcare costs for chronic conditions such as diabetes and asthma.

Noting that about 70% of all Medicare patients get their prescriptions filled at local drug stores, lead author Janice Pringle, PhD, associate professor and director of the Program Evaluation and Research Unit (PERU) at Pittsburgh’s School of Pharmacy, suggested that pharmacists should do more for patients than just prepare medications.

“This untapped resource could be harnessed and used to improve public health and reduce overall health care costs,” Pringle noted. “If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically, and the risk for severe health problems, such as heart attack or stroke, would be reduced. Patients would live longer and probably enjoy a higher quality of life.”

For the study, PERU staff trained 283 community pharmacists at short workshops to question patients about medication adherence using established survey tools. In addition, the pharmacists were instructed on how to have a brief dialogue with patients whose screening scores indicated they were at risk of poor medication adherence. That conversation could include questions and reassurances about side effects or urging patients to report back after taking the medication for a period of time.

The screening and brief intervention approach (SBI) was implemented at 107 Rite Aid pharmacies where, during 2011, 29,042 people had prescriptions filled under the program. Another 30,454 patients used 111 control pharmacies not utilizing SBI. Medication adherence was evaluated using insurance claims and a measure called Proportion of Days Covered (PDC). With a PDC of 80% (meaning the medication was taken for at least 80% of the expected period, which is considered to be the minimal medication dose needed to achieve the desired clinical outcome), researchers calculated PDC80 values for both the intervention year and for 2010, the year prior to SBI implementation.

Results indicate that, for the five classes of common medications the researchers reviewed, PDC80 rates increased in the SBI group during the intervention compared to the control group, ranging from 3.1% for beta blockers to 4.8% for oral diabetes medications.

Authors report that about 75% of the net improvement was because patients who were at high risk for poor medication adherence achieved the PDC80 benchmark after the intervention.

Annual healthcare costs dropped an average of $341 for each SBI patient taking oral diabetes drugs and $241 for those patients using statins.

Coauthor Jesse McCullough, PharmD, director of field clinical services at Rite Aid Corp., suggested that the cost savings “should draw the attention of many payers to the value of leveraging pharmacists in the community where their members live to improve health and wellness and reduce overall health care costs. This is another area where the value of the pharmacist to the health care system is demonstrated.”

Another coauthor, Mark Conklin, PharmD, vice president at Pharmacy Quality Solutions, added that the project “demonstrated that realizing untapped clinical performance value from a network of pharmacies is as much about the ability of a health plan to foster a supportive environment as it is about the ability of a pharmacy to execute an improvement effort.”

Pharmacists using SBI at the pharmacies received monthly feedback reports that allowed them to gauge their performance compared to other study participants and helped them identify patients at risk for nonadherence.



U.S. Pharmacist Social Connect