- Patients who are able to collect all their prescriptions during a single trip to the pharmacy are up to thirteen percent more likely to demonstrate acceptable medication adherence, says a new study published in Health Affairs.
The research, a collaborative effort between Humana and the University of Pennsylvania, found that Medicare patients who had demonstrated poor medication adherence in the past improved their compliance by between 9 and 13 percent when they did not have to make multiple stops at the pharmacy each month.
Even patients who were relatively adherent to their regimens were 3 to 5 percent more likely to follow instructions more closely when given the option to synchronize their prescription refills.
“Synchronizing refills has become a popular strategy to help improve medication adherence, but until now there was not much research about its effectiveness,” said William Fleming, President of Humana Pharmacy Solutions. “Our research shows that synchronization is an effective intervention, especially for patients with low adherence.”
The strategy may be a simple way to boost medication adherence rates among patients who struggle to access the pharmacy on a regular basis, the study suggests. Because patients who had previously experienced low adherence rates were among the most likely to improve, the research points to a lack of synchronization as one of the more significant barriers to compliance.
The researchers, led by Jalpa A. Doshi, PhD, associate professor of Medicine in the Perelman School of Medicine at the University of Pennsylvania, examined more than 1300 Medicare patients taking between 2 and 6 medications each month, with an average of 4.55 prescriptions.
These prescriptions included some of the most common chronic disease management medications, such as antihypertensives, lipid-lowering drugs, and antidiabetic medications.
Overall, the patients who were offered a synchronized pick-up schedule were 3 percent more adherent to hypertension medications, 4 percent more likely to take their cholesterol control, and 5 percent more likely to stay on top of their diabetic management.
Among patients who had exhibited poor medication adherence skills at the study baseline, the results were even more dramatic. This group improved antihypertension adherence by 9 percent, diabetic treatment adherence by 10 percent, and lipid-lowering drug adherence by 13 percent.
The study is not the first to suggest that simple scheduling fixes may be able to significantly improve medication adherence. A separate study from the American Journal of Managed Care, published in July, found that allowing patients to pick up their medications at the physician’s office immediately following an appointment improved adherence to the same trio of medication types by nearly 30 percent.
When diabetic Medicare patients received their prescriptions at the point of care, they improved their adherence to oral diabetes medications by 17 percent, blood pressure drugs by 21 percent, and cholesterol medications by a staggering 29 percent.
Even small improvements in medication adherence, especially for chronic diseases like hypertension, asthma, and diabetes, can make a significant difference in patient outcomes and long-term complications – not to mention the costs of care.
Non-adherence to diabetes management plans, for example, can result in a 17 percent increase in HbA1c measurements, as well as a 137 percent increase in the likelihood of developing end-stage renal disease.
Poor medication adherence also spikes a diabetic’s chance of experiencing severe vision loss or blindness, amputations, and cardiovascular issues. Nearly half of diabetics are considered non-adherent to their medication regimens.
The synchronization study speaks directly to the main issues that drive medication non-adherence: patient behaviors. A 2015 study by Express Scripts noted that close to 70 percent of medication adherence issues are due to patient forgetfulness, procrastination, or confusion about how to acquire their prescriptions.
In 2013, the costs of non-adherence totaled $337 billion, averaging out to more than $9000 per patient. The report also flagged delivery and pick-up problems as one of the main drivers of medication adherence issues. Express Scripts uses a predictive analytics methodology to identify patients at risk of low adherence rates and match those patients with the best delivery mechanisms for their needs.
Despite the evidence that medication synchronization may be a relatively easy way to encourage better patient behaviors and reduce the opportunities for mistakes and forgotten refills, few pharmacies are currently engaging in the strategy.
Only ten percent of independent pharmacies and 11 percent of retail store pharmacies offer synchronized refill options for their customers, according to recent research. The literature review, headed by authors from Brigham and Women’s Hospital in Boston, found that the popularity of such programs is growing rapidly, but the hard evidence for their success remains elusive.
Nonetheless, the common sense approach to medication adherence may hold promise for the millions of patients with multiple chronic diseases and a laundry list of prescriptions to fill. If synchronization is particularly effective for poorly adherent patients, as the Health Affairs study indicates, it may be a low-cost way to address some of the most impactful negative patient behaviors and raise the baseline adherence rate for a large number of patients.