Community Pharmacy Adherence Services
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Presentation Transcript
Adherence to Prescription Medication • Many patients have difficulty taking prescription medications as prescribed. • Poor adherence causes avoidable hospitalizations, premature deaths and increases the cost of health care*. *Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97. Cutler DM, Long G, Berndt ER, et al. The Value of Antihypertensive Drugs: A Perspective on Medical Innovation. Health Aff (Millwood) 2007;26:97-110. Thinking Outside the Pillbox. A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. August 2009. Available at www.nehi.net.
Common Factor Among Nonadherent Patients • Complexity - Multiple disease states, multiple prescribers, multiple disease, multiple drug therapies and multiple pharmacies • Result - Patients are confused.
What Happens When Patients Have Multiple Medications*? • 464 English speaking patients receiving care in one of three federally qualified health centers in Chicago, Illinois • Patients were given 7 prescription bottles with varying direction and asked when they would take each medication. The prescriptions could be consolidated into 4 doses/day *Wolf et al. Helping Patients Simplify and Safely Use Complex Prescription Regimens. Arch Intern Med 2011.
Patient Characteristics • Age 55-59 (29.3%),60-64 (33.2%), >64 (37.5%) • Race White (60.8%), African American (29.7%), Other (9.5%) • Education High School or less (17.7%), Some college (20.9%), College graduate (61.4%) • Literacy Low (20.7%), Marginal (22.8%), Adequate (56.5%)
Results • Dosing Regimen – Average 6 times/day (SD 1.8) Range 3-14 times/day • 30.8% of patients did not take drugs E & F at the same time (despite same directions) • 79% of patients did not take drugs A (twice daily) & B (every 12 hours) at the same time.
Community Pharmacy Solutions • Adherence Services designed to address: • Access - Ensure the patient has the correct medication. • Instructions - Ensure the patient knows how to take the medication.
Research on Community Pharmacy Solutions* • Subjects – 273 clients in a state Medicaid home and community-based waiver program—a waiver program for persons eligible for nursing home care, but who prefer to receive their services in the community • Intervention – Medication Adherence Packaging System & Coordinating Service. • Results – Matched control group was 2.94 times more likely to be admitted to a nursing home. *Schultz RM et al. Impact of a Medication Management System on Nursing Home Admission Rate in a Community-Dwelling Nursing Home–Eligible Medicaid Population. AmJ Geriatr Pharmacother. 2011;9:69–79
Mass Independent Pharmacists Assn. • Has many pharmacies located across the state providing a variety of solutions. • Willing to survey members to determine which pharmacies are offering these services. • Goal - Establish a network of pharmacies that can be used by patients who need this service.
Issues to be Discussed • Identify the service(s) that are desired. • Determine which patients would utilize the services. • Who will pay for these services. • Analysis of the results.
Two Examples • Saad Dinno (Acton Pharmacy) • Tim Fensky (Sullivan’s Pharmacy)