Medication‐related problems in chronic inflammatory conditions: A pharmacy claims and electronic health record analysis

Abstract

BackgroundSpecialty medications have transformed management of chronic inflammatory conditions. There is a critical need to elucidate underlying barriers and medication‐related problems (MRPs) that might contribute to specialty medication non‐adherence in order to minimize disease progression, treatment failure, and increased healthcare utilization.ObjectiveTo characterize MRPs for patients taking specialty medications for chronic inflammatory conditions and identify factors associated with experiencing MRPs.MethodsRetrospective cohort study of patients prescribed specialty medications for chronic inflammatory conditions at a single, regional, tertiary medical center, who filled their prescriptions at Walgreens pharmacy between 1/1/2014 and 12/31/2016. Electronic health records were manually reviewed to find documented medication problems. MRPs were then analyzed to identify common themes. Differences in baseline characteristics for patients with or without documented MRPs were compared using Fisher's exact test for categorical variables and Mann Whitney U test for continuous variables. Student's t test was used to determine associations between 12‐month proportion of days covered (PDC) and the presence of any MRP.ResultsOf 272 patients who were prescribed specialty medications for chronic inflammatory conditions, 98 patients (36%) experienced a total of 131 documented MRPs. Four major themes associated with these problems emerged: prescription processing issues (31%), insurance problems (24%), medication use problems (22%), and side effects (18%). Patients were less likely to have a documented MRP if they were African American (P = .032) and patients with MRPs had a greater proportion of missed clinic visits. Mean 12‐month PDC (n = 167) was 0.61 and was not significantly associated with having a documented MRP (P = .7).ConclusionUse of specialty medications for patients with chronic inflammatory conditions continues to increase. Gaining a greater understanding of the MRPs that affect specialty medication use for chronic inflammatory conditions can help identify practice innovations and policies to improve patient care.

What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials

“…12,14,15 Adherence is influenced by a multitude of interlinked patient-related and healthcare-related factors (eg, symptoms, treatment type, administration route, side effects, medication costs, healthcare beliefs, social circumstances, and culture). [11][12][13] These result in multiple barriers to adherence behaviour. 16 Barriers include perceptual and motivational issues (eg, intentionally missing doses through treatment concerns or wanting to be normal) or practical capabilities (eg, unintentionally forgetting doses).…”

“… 11 , 12 This can lead to the adverse effect of poor disease control. 13 More specifically, due to the fluctuating nature of IBD, for example, being “ill”, has been reported by some people living with IBD as not necessarily a continual state. Certain patients have taken this to mean that medication should only be taken during “illness” or flare-ups.…”