Community pharmacists can take a greater role in helping their patients adhere to their medication regimens, leading to a reduction in emergency room (ER) visits and hospital admissions, according to a new study led by researchers at the University of Pittsburgh School of Pharmacy.
The findings, reported in Health Affairs, also suggest that greater medication adherence lowers healthcare costs for a variety of chronic conditions, including diabetes and asthma.
Surveys indicate that approximately 70 percent of all Medicare patients get their prescriptions filled at neighborhood drug stores, says lead investigator and Healthcare Intelligence Network consultant Janice Pringle, Ph.D., associate professor and director of the Program Evaluation and Research Unit (PERU) at Pitt’s School of Pharmacy. Pharmacists need to take advantage of this opportunity to do more for patients than just prepare medications; their training, knowledge and community accessibility makes them the ideal health professionals to help people learn how and why to take their medications.
“This untapped resource could be harnessed and used to improve public health and reduce overall health care costs,” Dr. 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, dubbed the Pennsylvania Project, 283 community pharmacists were trained at short workshops by PERU staff to ask customers a few quick questions about medication adherence using established survey tools. They were taught to have brief dialogues with patients whose screening scores indicated they were at risk of not taking their medications as prescribed by their doctors. The conversation might include questions and reassurances about side effects or to request that the patient talk to the pharmacist after taking the medication for a little while to report how they were feeling.
During 2011, 29,042 people had prescriptions filled at 107 Rite Aid pharmacies that implemented the screening and brief intervention approach (SBI) and 30,454 people who went to 111 “control” pharmacies that didn’t use SBI.
The research team then reviewed insurance claims data to evaluate medication adherence with a measure called “Proportion of Days Covered” or PDC. A PDC of 80 percent, meaning the medication was taken for at least 80 percent of expected period, is considered to be the minimal medication dose needed to achieve the desired clinical outcome. PDC80 values were calculated for both the intervention year and for 2010, the year prior to SBI implementation.
Among the key findings were the following:
- 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 percent for beta blockers to treat high blood pressure to 4.8 percent for oral diabetes drugs.
- About 75 percent of the net improvement was due to patients who were at high risk for poor medication adherence achieving the PDC80 benchmark after the intervention.
- Healthcare costs dropped by $341 annually per person for SBI patients taking oral diabetes drugs and by $241 for SBI patients taking statins to lower cholesterol.
Each SBI pharmacy also received monthly PDC-measure feedback reports through CECity’s cloud-based performance management platform that allowed pharmacists to gauge their performance relative to peers and helped them identify their population of patients at risk for non-adherence.
Source: University of Pittsburgh, August 4, 2014
Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and Telepharmacy describes a number of interventions in which pharmacists help to guide patients and health plan members to higher levels of medication adherence — programs that take place in the pharmacy, in the physician practice, or virtually.