Impact of Community Pharmacist Interventions With Managed Care to Improve Medication Adherence

Abstract

Background: Nonadherence to medications is a concern due to adverse outcomes and higher costs of care. The Centers for Medicare and Medicaid Services has made adherence a key measurement for Star ratings. Objective: To evaluate the impact of a collaborative pilot program between a third-party payer, local pharmacy organization, and academic institution focusing on improving medication adherence with community pharmacies. Methods: Twenty-five community pharmacies implemented adherence-based interventions in patients ≥65 years old, who were Medicare Advantage Plan members, taking targeted medications (statins, oral diabetic medications, angiotensin-converting enzyme inhibitors [ACE-Is] and angiotensin receptor blockers [ARBs]). Outcome measures were (1) pharmacy intervention completion rate, (2) type of adherence interventions, (3) change in the proportion of days covered (PDC) following pharmacist intervention based on adherence group, and (4) nonadherence barriers. Results: A total of 1263 interventions met the eligibility criteria, and common interventions included explaining the benefit of the medication (n = 453, 35.9%) and provider follow-up (n = 109, 8.6%). Among nonadherent subjects who became adherent, the mean PDC increased by 14% (74%-88%, P < .0001), with a 12% decrease in mean PDC score in the nonadherent who remained nonadherent group (71%-58%, P < .0001). Common patient barriers for nonadherence were forgetfulness (n = 451, 35.7%) and denial (n = 84, 6.7%). System and therapeutic barriers included complexity (n = 155, 12.3%) and adverse side effects (n = 42, 3.3%). Conclusion: This collaborative effort successfully implemented a community pharmacist-led adherence intervention in 25 independent pharmacies. Our findings highlight increased interactions with patients and in some cases improved adherence measures. Future research must include implementation outcomes in order to effectively implement these interventions in the community pharmacy setting.

Intervention by clinical pharmacists can improve blood glucose fluctuation in patients with diabetes and acute myocardial infarction: A propensity score‐matched analysis

“…Clinical pharmacists provide several clinical pharmacy services to promote the rational use of medications in diabetic patients, inducing a thorough evaluation of the patient status, providing suggestions on drug treatment to physicians, delivering relevant education to patients. 9,10 Compared to the usual care regime, pharmacist interventions have resulted in favorable improvements in the blood glucose indices including hemoglobin A1c (HbA1c), and fasting blood glucose (FBG), as well as other cardiovascular risk factors involving blood pressure, body mass index (BMI), total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides. 11 However, evidence supporting the effects of clinical pharmacist interventions on the blood glucose fluctuations are limited.…”

Evaluation of a Novel Pharmacist-Delivered Adherence Improvement Service via Telehealth

“…Common interventions included explaining the benefit of the medication, provider followup and recommendations of adherence aids, such as pill boxes and changes to 90-days supplies. Post interventions mean PDCs increased by 14% (74-88%, p < 0.0001) [14].…”

“…Overall, 69% of patients with hypertension and 64.3% of patients with type 2 diabetes reached a PDC greater than 80% within 3 months [13]. Another collaborative pilot program with community pharmacists assessed targeted medications among Medicare members and a variety of adherence-based interventions [14]. Common interventions included explaining the benefit of the medication, provider followup and recommendations of adherence aids, such as pill boxes and changes to 90-days supplies.…”

Pharmacists' perceptions on patient care services and social determinants of health within independent community pharmacies in an enhanced services network

“…Even with limited software utilization, community pharmacies still offered a variety of PCS and adherence tools and patient communication strategies. [21][22][23][24][25][26] Community pharmacies are seeking available technology and resources such as access to electronic health records for the ability to document PCS. 5 In a qualitative study, Daly et al interviewed community pharmacists to inquire how technology is a driving force behind the efficiency and effectiveness of PCS delivery.…”