Fresh research by Walgreen Co. and CVS Caremark Corp. reveals that a more personal, precise approach to improving medication adherence is more successful.

Walgreens, CVS Caremark, medication adherence, face-to-face counseling, pharmacist, pharmacist face-to-face counseling, statin therapy, Jeff Kang, Patient Preference and Adherence, medication nonadherence, adherence interventions, Cardiovascular Medication Adherence Interventions, Harvard University, Brigham and Women's Hospital, CVS Caremark, Journal of the American Pharmacists Association, Troy Brennan, Sarah Cutrona

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Walgreens, CVS studies gauge Rx adherence guidance

June 1st, 2012

NEW YORK – Fresh research by Walgreen Co. and CVS Caremark Corp. reveals that a more personal, precise approach to improving medication adherence is more successful.

The Walgreens study found that patients starting high cholesterol medication (statin) who participated in enhanced, face-to-face counseling sessions with a pharmacist demonstrated better medication adherence than those who didn't partake in such sessions. The study, titled "The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy," was published in April edition of the online journal Patient Preference and Adherence.

Meanwhile, the research sponsored by CVS Caremark showed that adherence interventions targeted to patients identified as nonadherent were more effective than broad interventions that cast a wide net to encompass all medication takers. The study, titled "Targeting Cardiovascular Medication Adherence Interventions," was conducted by researchers at Harvard University, Brigham and Women's Hospital and CVS Caremark and was published in the May/June issue of the Journal of the American Pharmacists Association.

In the Walgreens study, pharmacists trained in brief motivational interviewing conducted counseling sessions that addressed barriers to adherence for statin patients, such as perceptions of the value of the therapy, fear of side effects and simple forgetfulness or establishing a routine to take medication. Outcomes were measured using three metrics for evaluating adherence: continuous medication possession ratio (MPR), categorical MPR and medication persistency.

The study found that at 12 months the intervention group of 586 patient had significantly greater adherence (an average of 61.8%) than the comparison group of 516 patients (an average adherence of 56.9%).

What's more, 40.9% of the intervention group and only 33.7% of comparison group achieved the clinically important 80% adherence, and 43.9% of the intervention group and 38.2% of comparison group continued taking their statin medication.

"This study demonstrates the power of face-to-face pharmacist interactions," stated Jeff Kang, MD, Walgreens' senior vice president of health and wellness services and solutions. "Just two sessions focused on barriers to adherence for patients taking a new medicine for high cholesterol helped them establish a routine for adhering to their treatment. As a result, these patients potentially improved their long-term health outcomes."

In the CVS study, researchers found that more than one-third of adherence interventions targeted to nonadherent patients resulted in improved medication adherence, compared with 18% of broad interventions.

"While medication nonadherence is widely recognized as a major public health issue that impacts patient health and contributes to rising health care costs, there has not been a clear consensus about how best to influence patient behavior and support appropriate medication use," explained Sarah Cutrona, M.D., a former research associate at Brigham and Women's Hospital. "These results suggest that broad interventions, which aim to prevent nonadherence by educating and motivating all patients, were the least effective. Without the benefit of identifying patients and their specific barriers to adherence, these types of interventions may be too general to motivate individual patients to change their medication taking behavior."

The researchers reviewed nearly 60 peer-reviewed articles about randomized controlled trials for three types of interventions to improve medication adherence for cardiovascular disease or diabetes. These interventions included broad interventions targeting all patients, focused interventions targeting nonadherent patients and dynamic interventions initially administered to all patients but then targeted to nonadherent patients based on real-time adherence information. Results found that dynamic interventions (32%) and focused interventions (25%) were more likely to show impact on adherence as compared to broad interventions (18%).

"This study is part of our ongoing research collaboration with Harvard and Brigham and Women's Hospital to better understand the factors that impact mediation adherence," stated Troy Brennan, executive vice president and chief medical officer of CVS Caremark, who heads the research initiative that conducted the study. "We believe these results can be useful in helping to develop and better target adherence interventions so they are relevant for the patient and enable them to make better choices about their medications and achieve positive health outcomes."

The researchers concluded that targeting patients who are nonadherent to their cardiovascular medications may lead to better adherence, but more research is needed to determine how best to identify and intervene with nonadherent patients.