The research included patients initiating therapy within 16 drug classes used to treat common chronic conditions over a six-month period in 2013, and compared data from 72,410 Walgreens patients with an equal number of patients using other pharmacies. The Walgreens patient data were matched to de-identified patients from other pharmacies based on a variety of factors that included drug class, demographics, clinical factors, prior health care utilization and costs. The two groups had similar age, gender and disease burden characteristics.
“These findings clearly illustrate that the combination of pharmacist counseling, medication therapy management, refill reminders and telephonic and digital pharmacy interventions, tailored to patients’ needs, drive better adherence,” says Michael Taitel, senior director of health analytics, research and reporting for Walgreens and one of the study’s authors. “Further, this improvement in adherence results in fewer hospitalizations and emergency room visits, ultimately benefiting payers by lowering the overall cost of care.”
According to Catherine MacPherson, vice president of adherence innovation for Walgreens, patient adherence was quantified using a measure called proportion of days covered (PDC) across each of the drug classes. Each patient was considered adherent if his or her PDC was greater than 80%, a commonly used threshold.
As Taitel noted, the Walgreens interventions included pharmacy-based patient counseling, medication therapy management and online and digital refill reminders. The programs for new-to-therapy patients included pharmacist calls and consultations, while those patients continuing therapy received MTM consultations, automated reminders, pickup reminders, late-to-fill reminders and face-to-face consultations.
The results showed that Walgreens patients had 1.8% fewer hospital admissions and 2.7% fewer emergency room visits. Walgreens patients also incurred lower pharmacy costs ($92 lower), outpatient costs ($120 lower), emergency room costs ($38 lower) and total health care costs ($226.07 lower) over a six-month period. Overall, Walgreens new-to-therapy patients had 3% lower total health care costs than their non-Walgreens counterparts.
MacPherson notes that since the study was conducted, Walgreens has added some services, such as text-refill reminders and script-ready text notifications, and tweaked others. “For example, post-study we changed the new-to-therapy consultation from a face-to-face interaction that can occur when a patient picks up a new medication to a phone consultation three days after that patient takes the new medication home,” she explains. “We made this change after learning in separate analysis that patients have more questions after they begin taking the new medication versus upon pickup.”
Some studies indicate that only about 50% of patients with chronic conditions take their medications as prescribed, with a resulting cost to the U.S. health care system of up to $289 billion annually.
“The most actionable conclusion we can draw from this study is that, when it comes to adherence, the most effective solution can differ with each patient,” MacPherson says. “A comprehensive adherence program needs to provide support over time and must adapt to changes — barriers, needs, preferences — of patients as well as their caregivers, and the system as a whole. Generally, the best solution is a combination of touch points and longitudinal support for the patient, the care team and the broader system.”