Improving Medication Adherence through Workplace Primary Care and Pharmacy

1. Improving Medication Adherence through Workplace Primary Care and Pharmacy Bruce Sherman, MD, FCCP Medical Director The Goodyear Tire & Rubber Company

2. Today’s discussion • Medication adherence, compliance, and persistence - definitions • Healthcare cost impact of poor adherence • Reasons for poor adherence and approaches to improvement • Role of worksite medical clinics and pharmacy in improving medication adherence

3. The language of medication adherence • Compliance: how well a patient follows physician orders within a designated timeframe • Adherence: same as compliance • Persistence: how long a patient remains on therapy after starting • Medication Possession Ratio (MPR): the total days’ supply of medication obtained during the period of persistence, divided by the corresponding number of calendar days (non-adherence is defined as an MPR of < 80%).

4. Medication adherence – hyperlipidemia treatment Compliance by medication class reveals greater adherence variability

5. Persistency of medication use – statins • Key points: • 30% of statin users have <80% adherence • Of new users, 20% stop statin medication after first prescription

6. Lower medication adherence results in higher overall healthcare costs

7. Economic impact of poor medication adherence • Only about 50 percent of American patients typically take their medicines as prescribed, resulting in approximately $100 billion in annual direct costs • An estimated 10% of hospitalizations are attributable to poor adherence • Not taking medicines as prescribed has been associated with as many as 40 percent of admissions to nursing homes • Additional $2,000 a year per patient in medical costs for visits to physicians' offices. National Council on Patient Information and Education, 2007

8. Multiple contributors to poor adherence • Cost • Understanding of condition • Provider relationship • Provider continuity • Provider follow-up • Medication dosing schedule • Comorbid conditions and other medications • Side effects • Perceived benefit from medication • Self-efficacy • Motivation

9. Lower co-pays can improve clinical outcomes and reduce costs * *157 patients were eligible for both the economic and clinical cohorts; $18,000 is equivalent to the salary of 1 FTE for the employer within which the analysis was completed

10. Patient-centered solutions Med-eMonitor System • Interactive patient medication dispensing device • Automated reminders • Networked to track adherence Demonstrated clinical outcomes – Medicare population • Adherence increased from 40% to 92% for diabetes • HbA1C levels declined by 18% in 3 months ? Applicability to workforce InforMedix Medication Adherence Solution

11. Patient-centered solutions

12. Focus on statins: Research results to improve adherence

13. Interventions and their potential impact on barriers to medication adherence

14. A multidisciplinary approach is likely a more effective solution • Integrate: • cost incentives • improved access • patient education/empowerment • quality management • Worksite clinic/pharmacy incorporates these components • Demonstrable results

15. On-site clinic and pharmacy • Key attributes: • Improved patient access • Integrated service delivery • Reimbursement model isn’t driven by CPT billing or volume • Enhanced attention to preventive care and chronic condition management • Integrated tracking of prescription adherence with provider reports

16. On-site medical and pharmacy use increases medication adherence CHD Meridian/Goodyear

17. Integrated worksite care: favorable adherence shift to higher quintiles Adherence Profile for Diabetics Taking Insulin CHD Meridian/Goodyear

18. Summary • Patient, provider and health system all contributors to suboptimal medication adherence • Treatment to target a major additional consideration • Multidisciplinary interventions are likely to be most effective • Worksite pharmacy/clinic model promotes adherence and treatment to target goals