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Pharmacy Interventions May Improve Medication Adherence Rates

Medication adherence interventions rooted in the retail pharmacy setting may help to improve chronic disease management for patients while cutting healthcare spending.

By Jennifer Bresnick

- Medication adherence interventions that take place at a patient’s retail pharmacy may be able to help patients stay on track with their therapies and reduce the number of preventable hospitalizations, according to a new study in the journal Population Health Management.

Chronic disease management and medication adherence interventions

When retail pharmacists provided medication adherence counseling and education to more than 72,000 patients over a six-month period in 2013, the patient population experienced 1.8 percent fewer hospital admissions and 2.7 percent fewer emergency department visits.

Patients participating in the intervention plan also incurred lower overall healthcare costs, indicating that population health management strategies must include more than just the primary care provider if they are to produce meaningful, positive patient results.

“Patients receiving a new chronic diagnosis and medication therapy are at very high risk for non-adherence to medication, and this important study demonstrates how a diverse set of pharmacy and digital interventions improves care while reducing total healthcare costs,” said Harry Leider, MD, Chief Medical officer at Walgreens, where the study took place.

Medication non-adherence is one of healthcare’s costliest problems, affecting more than half of patients and bringing millions of dollars in avoidable costs to payers and providers. 

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A recent study by Express Scripts found that the majority of medication adherence issues can be traced back to patient behaviors, including procrastination and forgetfulness, fear of their medication’s side effects, and inability to pay for their prescriptions.

Interventions that take place at the pharmacy may be able to mitigate many of these non-adherence factors, says the Walgreens study.

“Pharmacist counseling is important because although a patient’s physician has a role to play in the patient’s adherence to medications as prescribed, from the healthcare system standpoint, the physician’s ability to identify nonadherence is limited,” explains lead author Michael Taitel, PhD.

“Community pharmacists are uniquely positioned to help mitigate the high risk of medication discontinuation and improve adherence for patients initiating therapy because of their access to prescription refill information and frequent interactions with patients.”

The study examined data from approximately 145,000 patients, half of which received pharmacy services at a location that provided medication adherence interventions, and half at a separate location.  The researchers focused on sixteen common medication categories used to manage chronic diseases, including antidepressants, diabetic medications, beta blockers, diuretics, and thyroid agents.

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Patients in the intervention group received counseling and medication management services, as well as online and digital refill reminders.  Patients starting a new therapy received a pharmacist call or face-to-face consultation within three days of their first prescription pickup. 

During the consult, the pharmacist would assess the patient’s commitment to following his or her treatment plan and address any questions that the patient might have about the process.  Patients who completed this session were also eligible for a second consultation after their second prescription fill.

These strategies reduced the spending of new-to-therapy patients by 3 percent, and slashed overall health care spending for all intervention patients by a total of $226 over six months.  The reductions included pharmacy savings ($92), outpatient savings ($120), and ED expenditures ($38).

“This data quantifies the role our community pharmacy platform plays in achieving better population health outcomes,” said Taitel, who is Senior Director of Health Analytics, Research, and Reporting at Walgreens.

While the study may indicate that pharmacy-based interventions can improve overall chronic disease management while reducing costs, it is important to note that the authors are employees of Walgreens Co. and received funding for their work from the pharmacy corporation.

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Despite this potential conflict of interests, the results do align with other studies that show patient management techniques must extend into the community, and that medication counseling and education at the pharmacy can play an important role in ensuring that patients remain adherent to their treatment plans.

A study from Brigham and Women’s Hospital and Harvard Medical School published earlier this year suggests that synching a patient’s medication pick-up schedule could help to simplify his or her ability to manage multiple therapies. 

At San Francisco General Hospital, providing personalized medication adherence education to high-risk, complex patients before discharge from the hospital helped to slash readmissions by up to 70 percent.  By providing instructions and other materials in the patient’s native language, pharmacists were able to ensure that the patients understood how to use their prescriptions once they returned home.

Medication adherence programs that include pharmacists could be a low-cost and effective way to guide patients through chronic disease management while reducing the potential for adverse outcomes such as preventable hospitalizations.   

“The combination of pharmacist counseling, medication therapy management, refill reminders and telephonic and digital pharmacy interventions, tailored to patients’ needs, drive better adherence,” Taitel concluded. “Further, this improvement in adherence results in fewer hospitalizations and emergency room visits, ultimately benefitting payers by lowering the overall cost of care.”

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