Association of increased emergency rooms costs for patients without access to necessary medications

Patient outcomes from implementing an enhanced services pharmacy network

OBJECTIVE

To evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending.

DESIGN

Quasi-experimental difference-in-difference analysis with a nonequivalent control group.

SETTING AND PARTICIPANTS

Eligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016. A control group was propensity score-matched. Interventions consisted of enhanced services and a more intensive, comprehensive initial pharmacy assessment (CIPA).

OUTCOME MEASURES

Outcomes included hospitalizations; emergency department (ED) visits; health care spending for total medical, inpatient, outpatient, and ED services; and adherence to renin-angiotensin system antagonists (RASA), statins, noninsulin diabetes medications (NIDM), and multiple medications for chronic conditions (MMCC).

RESULTS

There were 31,509 patients who met eligibility criteria and were attributed to a participating pharmacy. Of these, 3897 received a CIPA. Before matching, patients attributed to participating pharmacies had greater Medicaid enrollment through aged, blind, or disabled status (49.2% vs. 31.5%, P < 0.001); greater case management (10.3% vs. 7%, P < 0.001); and worse rates of chronic disease (P < 0.001). Successful matching removed these differences. Adherence to RASA medications and MMCC increased by 9.5% and 10.3% (P < 0.05), respectively. Adherence did not change for statins and NIDM. The analysis also revealed a slower decline in average total medical spending of 5.7% (P < 0.01) relative to the control group over the same period, owed to a 9.6% (P < 0.001) slower decline in outpatient spending. ED utilization also decreased more slowly relative to controls by 4.8% (P < 0.05) following the intervention.

CONCLUSION

The pharmacy intervention resulted in a statistically significant improvement in medication adherence to RASA and multiple chronic medications, but did not change or may have worsened utilization and spending outcomes. More research is needed to explore patient selection and variation in implementation and heterogeneity of treatment effects when evaluating pharmacy interventions.

Impact of a Simulation Exercise on Pharmacy Student Attitude toward Poverty

Objective. To evaluate the impact of a simulation on pharmacy student attitudes toward poverty using the Attitude toward Poverty (ATP) Short Form scale. Methods. Second-year pharmacy students participated in the 3-hour Missouri Association for Community Action Poverty Simulation. Students completed a survey of the ATP Short Form scale prior to and following participation in the simulation. Results. Significant improvements in attitude were noted in 15 of 21 ATP Short Form items. Improvements in the stigma and structural domains were significant while improvement in the personal deficiency domain was not significant. Conclusions. This poverty simulation exercise positively altered pharmacy student attitudes toward poverty. When combined with didactic and experiential curriculum, this simulation may enhance student achievement of the 2013 Center for the Advancement of Pharmacy Education (CAPE) outcome subdomain of cultural sensitivity.

Continuous access to medication and health outcomes in uninsured adults with type 2 diabetes

BACKGROUND AND PURPOSE

Achievement of recommended targets for HbA1c, low-density lipoproteins (LDLs), and blood pressure (BP) improves outcomes in adults with diabetes. To meet targets, access to an affordable and consistent supply of medication is necessary, which can be challenging for the medically underserved. The Social Determinants of Health (SDOH) framework guided variable selection in this study, which explored the relationship between continuous access to medication and HbA1c, LDL, and BP in adults with type 2 diabetes who are uninsured and of low socioeconomic status.

METHODS

This study was conducted using archived medical record data and a convenience sample of adults (n = 65) who received health care on a mobile health van and medications from a pharmaceutical procurement program. Pre-post data were analyzed using dependent t-tests.

CONCLUSIONS

Continuous access to medication was related to improved HbA1c (p = .003), LDL (p = .004), and systolic BP (p = .025). Access to a consistent source of medications for chronic disease is related to improved health outcomes.

PRACTICE IMPLICATIONS

Knowledge was gained about the effect of improved access, nontraditional healthcare delivery systems, and improved outcomes related to collaboration among community partners. Interventions aimed at the wider SDOH may reduce disparities of the medically underserved.