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Study: Community pharmacist intervention raises adherence
August 6th, 2014
PITTSBURGH – Community pharmacists can make a big difference in helping patients adhere to their prescription drug regimens, according to a new study led by researchers at the University of Pittsburgh School of Pharmacy.
The pharmacy school said Tuesday that the findings from the Pennsylvania Project study, reported in the journal Health Affairs, also indicate that improved medication adherence can help reduce emergency room visits and hospital admissions, in turn lowering health care costs for chronic conditions, including diabetes and asthma.
About 70% of all Medicare patients get their prescriptions filled at neighborhood drug stores, but pharmacists can do more for patients than just dispense medications, according to lead investigator Janice Pringle, associate professor and director of the Program Evaluation and Research Unit (PERU) at the University of Pittsburgh School of Pharmacy.
"This untapped resource could be harnessed and used to improve public health and reduce overall health care costs," Pringle explained. "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, which was funded by the Pharmacy Quality Alliance and whose participants included Rite Aid Corp., 283 pharmacists were trained at short workshops by PERU staff to ask customers a few questions about medication adherence using established survey tools. They also were taught to have a brief dialogue with patients whose screening scores indicated that they were at risk of not taking their medications as prescribed by their doctors. The conversation might have included 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% — meaning the medication was taken for at least 80% of the expected period — is deemed 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 before SBI implementation.
For the five classes of common medications the researchers reviewed, PDC80 rates rose in the SBI group during the intervention compared with the control group, ranging from 3.1% for beta blockers to treat high blood pressure to 4.8% for oral drugs for diabetes.
About 75% of the net improvement was from patients at high risk for poor medication adherence achieving the PDC80 benchmark after the intervention. Health care 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.
"The cost savings demonstrated by the Pennsylvania Project 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," study co-author Jesse McCullough, director of field clinical services at Rite Aid, said in a statement. "This is another area where the value of the pharmacist to the health care system is demonstrated."
Michael Madden, vice president and chief medical officer at Gateway Health Plan, which provided pharmacy claims data for the study, noted that quality medical care is a "team sport," involving doctors, nurses, care managers, health plans, pharmacists and other providers. "Improving medication adherence rates improves quality, public health and saves money, and this study demonstrates the value pharmacists can add," he added.
Each SBI pharmacy also received monthly PDC-measure feedback reports through CECity's cloud-based performance management platform, which allowed pharmacists to gauge their performance relative to peers and helped them identify their population of patients at risk for nonadherence.
"The Pennsylvania 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," stated study co-author Mark Conklin, vice president at Pharmacy Quality Solutions. "The relationship between the two entities, based on shared objectives and continuous learning, is the key ingredient."
Other co-authors of the study included Annette Boyer, vice president of business development at CECity, and Arnie Aldridge of RTI International.
"The Pennsylvania Project is a perfect example of how a continuous learning health system model can be developed and scaled to improve quality and decrease the cost of patient care," Boyer commented.
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