Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization

Abstract

Objectives: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified. Methods: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified. Results: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not. Conclusions: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.

Medication therapy problem documentation and reporting: A review of the literature and recommendations

“…where from 1 month to 10 years, 12,52 with an average intervention length of 15.4 (±15.6) months. The number of MTPs identified ranged from 19 to 38 631, and the number of included patients ranged from 11 to 9068.…”

Systematic review of the impact of medication synchronization on healthcare utilization, economic, clinical, and humanistic outcomes

“…Study designs varied, with 1 (4%) randomized controlled trial, 24 3 (11%) quasiexperimental studies, 7,25,26 10 (41%) retrospective cohort studies, [27][28][29][30][31][32][33][34][35][36] 4 (15%) pre-post studies, 37-40 1 (4%) prospective cohort study, 41 1 (4%) cost-benefit analysis, 42 6 (19%) cross-sectional surveys, [43][44][45][46][47][48] and 1 (4%) chart review. 10 Med-sync was provided at different pharmacy settings, such as independent, chain, outpatient, and mail-order pharmacies.…”

“…Of the 27 studies, 26 were observational and had moderate to serious bias due to confounding and bias in selection of participants for the study (Table B1). 7,10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][43][44][45][46][47] All the non-randomized studies had a moderate bias in measurement of outcomes, while two studies had serious bias in measurement of outcomes. 42,48 Confounding was commonly seen as most of the med-sync programs were in conjunction with other programs, such as Medication Therapy Management (MTM), home delivery services, medication reconciliation, adherence packaging, or educational interventions.…”

“…The ABM med-sync program can mitigate certain patient barriers to taking medications as prescribed (e.g., missing doses, refilling the medication late, not refilling the medication, stock piling) and medication persistence (e.g., discontinuing medication before a recommended date), while also facilitating greater pharmacist oversight by addressing other medication therapy problems such as potential contraindications, duplicate drug therapy, and errors. 7,9,10 These programs also provide opportunities for counseling on targeted disease states and coordination of care for referrals to other providers. Barriers related to social determinants of health (e.g., affordability, living conditions, disability, transportation, and literacy) can also be identified and addressed more proactively as there is a regularly scheduled pharmacist-patient interaction.…”

Implementation of a Health Risk Assessment into Workflow of the Appointment-Based Model at an Independent Community Pharmacy

“…However, the 2-month timeframe of this pilot coupled with the program occurring during the first year of the COVID-19 pandemic did not enable us to realize the full financial potential for new vaccination opportunities. Fitzpatrick and colleagues conducted a retrospective study describing drug therapy problems identified in patients enrolled in an appointment-based model [ 22 ]. They found that vaccine recommendations were the second most commonly documented intervention.…”