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Ho JL, Roberts J, Payne GH, Holzum DN, Wilkoff H, Tran T, Cobb CD, Moore TD, Lee KC. Systematic literature review of the impact of psychiatric pharmacists. Ment Health Clin 2024; 14:33-67. [PMID: 38312443 PMCID: PMC10836561 DOI: 10.9740/mhc.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/01/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Pharmacists focusing on psychotropic medication management and practicing across a wide variety of healthcare settings have significantly improved patient-level outcomes. The Systematic Literature Review Committee of the American Association of Psychiatric Pharmacists was tasked with compiling a comprehensive database of primary literature highlighting the impact of psychiatric pharmacists on patient-level outcomes. Methods A systematic search of literature published from January 1, 1961, to December 31, 2022, was conducted using PubMed and search terms based on a prior American Association of Psychiatric Pharmacists literature review. Publications describing patient-level outcome results associated with pharmacist provision of care in psychiatric/neurologic settings and/or in relation to psychotropic medications were included. The search excluded articles for which there was no pharmacist intervention, no psychiatric disorder treatment, no clinical outcomes, no original research, no access to full text, and/or no English-language version. Results A total of 4270 articles were reviewed via PubMed, with 4072 articles excluded based on title, abstract, and/or full text in the initial pass and 208 articles selected for inclusion. A secondary full-text review excluded 11 additional articles, and 5 excluded articles were ultimately included based on a secondary review, for a final total of 202 articles meeting the inclusion criteria. A comprehensive database of these articles was compiled, including details on their study designs and outcomes. Discussion The articles included in the final database had a wide range of heterogeneity. While the overall impact of psychiatric pharmacists was positive, the study variability highlights the need for future publications to have more consistent, standardized outcomes with stronger study designs.
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Affiliation(s)
- Jessica L Ho
- Clinical Pharmacist, St. Peter Regional Treatment Center, St. Peter, Minnesota
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
- Pain Management/Substance Use Disorder Clinical Pharmacy Practitioner, VISN 20 Clinical Resource Hub, Boise, Idaho
- Clinical Pharmacy Specialist- Behavioral Health, Adventist HealthCare Shady Grove Medical Center, Rockville, Maryland
- Medical Science Liaison, Medical Affairs, Braeuburn, Plymouth Meeting, Pennsylvania; Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
- Founder and Consultant, Capita Consulting, Billings, Montana
- National Program Manager, Clinical Pharmacy, Clinical Practice Integration and Model Advancement Pharmacy Benefits Management (PBM), Colorado
- Professor of Clinical Pharmacy, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
| | - Jenna Roberts
- Clinical Pharmacist, St. Peter Regional Treatment Center, St. Peter, Minnesota
| | - Gregory H Payne
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
| | - Dorothy N Holzum
- Pain Management/Substance Use Disorder Clinical Pharmacy Practitioner, VISN 20 Clinical Resource Hub, Boise, Idaho
| | - Hannah Wilkoff
- Clinical Pharmacy Specialist- Behavioral Health, Adventist HealthCare Shady Grove Medical Center, Rockville, Maryland
| | - Tran Tran
- Medical Science Liaison, Medical Affairs, Braeuburn, Plymouth Meeting, Pennsylvania; Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Carla D Cobb
- Founder and Consultant, Capita Consulting, Billings, Montana
| | - Tera D Moore
- National Program Manager, Clinical Pharmacy, Clinical Practice Integration and Model Advancement Pharmacy Benefits Management (PBM), Colorado
| | - Kelly C Lee
- Professor of Clinical Pharmacy, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
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Pharmacist Interventions for Medication Adherence: Community Guide Economic Reviews for Cardiovascular Disease. Am J Prev Med 2022; 62:e202-e222. [PMID: 34876318 PMCID: PMC8863641 DOI: 10.1016/j.amepre.2021.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Adherence to medications for cardiovascular disease and its risk factors is less than optimal, although greater adherence to medication has been shown to reduce the risk factors for cardiovascular disease. This paper examines the economics of tailored pharmacy interventions to improve medication adherence for cardiovascular disease prevention and management. METHODS Literature from inception of databases to May 2019 was searched, yielding 29 studies for cardiovascular disease prevention and 9 studies for cardiovascular disease management. Analyses were done from June 2019 through May 2020. All monetary values are in 2019 U.S. dollars. RESULTS The median intervention cost per patient per year was $246 for cardiovascular disease prevention and $292 for cardiovascular disease management. The median change in healthcare cost per person per year due to the intervention was -$355 for cardiovascular disease prevention and -$2,430 for cardiovascular disease management. The median total cost per person per year was -$89 for cardiovascular disease prevention, with a median return on investment of 0.01. The median total cost per person per year for cardiovascular disease management was -$1,080, with a median return on investment of 7.52, and 6 of 7 estimates indicating reduced healthcare cost averted exceeded intervention cost. For cardiovascular disease prevention, the median cost per quality-adjusted life year gained was $11,298. There were no cost effectiveness studies for cardiovascular disease management. DISCUSSION The evidence shows that tailored pharmacy-based interventions to improve medication adherence are cost effective for cardiovascular disease prevention. For cardiovascular disease management, healthcare cost averted exceeds the cost of implementation for a favorable return on investment from a healthcare systems perspective.
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Bou Malham C, El Khatib S, Cestac P, Andrieu S, Rouch L, Salameh P. Impact of pharmacist-led interventions on patient care in ambulatory care settings: A systematic review. Int J Clin Pract 2021; 75:e14864. [PMID: 34523204 DOI: 10.1111/ijcp.14864] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In an era of rapid evolution in healthcare delivery, major changes have occurred within the profession of pharmacist. Because the impact of pharmacist-led interventions in the hospital setting has been well-studied and showed mixed findings on drug-related readmissions, all-cause emergency department visits and mortality, this systematic review focused on services provided by pharmacists in the community or ambulatory care setting without being limited to a specific intervention or outcome. OBJECTIVE To investigate the impact of pharmacist-led interventions, categorised into clinical medication review (CMR), adherence review (AR), and prescription review (PR) on various aspects of patient care (clinical, behavioural, economic and humanistic outcomes in ambulatory care setting) and understand which particular intervention makes the greatest contribution. METHODS A literature search was conducted using MEDLINE, Embase and the Cochrane Library for publications from 2000 onwards. FINDINGS AND INTERPRETATION A total of 31 relevant publications corresponding to 27 controlled trials (CTs) and 4 observational studies were selected. CMR was the most studied pharmacist-led intervention (n = 19, 61.29%), followed by AR (n = 6, 19.3%). CMR demonstrated a favourable effect on different clinical outcomes mainly the management of drug-related problems and adverse events, and it also contributed the most to the reduction of healthcare costs. AR was the most effective intervention to improve patient's adherence. CMR alone or combined with AR both raised equally the patient's satisfaction. CONCLUSION Our results showed that CMR can play a major role in the management of drug-related problems and economic issues. AR can significantly improve patient compliance. Larger, standardised and rigorously designed intervention studies are needed to help decision-makers to select appropriate interventions leading to meaningful improvements in patient care.
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Affiliation(s)
- Carmela Bou Malham
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- University Paul Sabatier Toulouse III, Toulouse, France
| | - Sarah El Khatib
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- University Paul Sabatier Toulouse III, Toulouse, France
| | - Philippe Cestac
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- University Paul Sabatier Toulouse III, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, Toulouse Cedex 9, France
| | - Sandrine Andrieu
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- University Paul Sabatier Toulouse III, Toulouse, France
- Department of Clinical Epidemiology and Public Health, CHU Toulouse, Toulouse, France
| | - Laure Rouch
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- University Paul Sabatier Toulouse III, Toulouse, France
- Department of Pharmacy, Toulouse University Hospitals, Purpan Hospital, Toulouse Cedex 9, France
| | - Pascale Salameh
- Faculties of Medical Sciences, Pharmacy & Public Health, Lebanese University, Hadath, Lebanon
- National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, Lebanon
- School of Medicine, University of Nicosia, Nicosia, Cyprus
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Mohan A, Vadhariya A, Majd Z, Esse TW, Serna O, Abughosh SM. Impact of a motivational interviewing intervention targeting statins on adherence to concurrent hypertension or diabetes medications. PATIENT EDUCATION AND COUNSELING 2021; 104:1756-1764. [PMID: 33402279 DOI: 10.1016/j.pec.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study explored if a motivational interviewing intervention customized for statins impacted adherence to concomitantly used antidiabetic/antihypertensive medications. METHODS The intervention was conducted among patients with a history of suboptimal adherence to statins and included 152 patients in intervention and 304 controls. This retrospective study design identified patients with claims for statins and either antidiabetic/antihypertensive medications. The outcome variable was adherence, measured as proportion of days covered ≥ 0.80, to antidiabetic/antihypertensive medications. Multivariable linear and logistic regression evaluated the effect of intervention on adherence to antidiabetic/antihypertensive medications during the 6 months post-intervention. RESULTS The antidiabetic group had 53 intervention patients and 102 controls. The antihypertensive group had 80 intervention patients and 159 controls. There was no significant improvement in adherence for antidiabetic/antihypertensive medications following the intervention. Adherence at baseline was a significant predictor of adherence post-intervention in the antidiabetic (OR = 6.5;P < 0.0001) and antihypertensive (OR = 4.1; P = 0.0001 & β = 0.09; P = 0.008) users. Physician specialty (OR = 3.902; P = 0.01& β = 0.09; P = 0.015) among antidiabetic users and age >70 years (OR = 2.148; P = 0.025) among antihypertensive users were predictors of adherence. CONCLUSION The intervention targeting statin did not significantly improve antihypertensive/antidiabetic adherence. PRACTICE IMPLICATIONS Targeted interventions tailored to patient past adherence and specific medications should be explored.
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Affiliation(s)
- Anjana Mohan
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | - Aisha Vadhariya
- Duquesne University School of Pharmacy Graduate School of Pharmaceutical Sciences, 418A Mellon Hall, United States.
| | - Zahra Majd
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | | | - Omar Serna
- CareAllies, Houston, Texas, United States.
| | - Susan M Abughosh
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
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Abstract
Background Community pharmacy practice needs to demonstrate services beyond traditional dispensing roles to continue to function in a changing marketplace. Pharmacists have established themselves as being capable of improving patient outcomes and saving healthcare dollars by providing disease management services to patients. This paper describes a sustained community pharmacy-run disease management program that continued after a grassroots grant-funding effort in 2007. Methods The city of Colorado Springs recognized the successes shown by the pharmacy during the Ten City Challenge funded project, and decided to financially support pharmacy diabetes care services. Partnering with the local School of Pharmacy, the pharmacist obtained advanced training and continued to deliver individualized counseling and management to approximately 100 patients per year for the past 14 years. Objective lab measurements (systolic and diastolic blood pressures, A1C values, total lipid profiles) were obtained or performed, and clinical goals were set based on national guidelines. Patients received a series of appointments to learn how to control their diabetes, and later their cardiovascular disease. Financial estimates were calculated using 2008 baseline numbers and adding estimated inflation based on published Segal rates. Results The pharmacy services successfully maintained participation of approximately 100 patients annually each year since its inception. Average lab value markers for disease control were at or close to clinical guideline recommendations for the population. Services were associated with estimated cost savings for the health system. Positive results led to expansion in services to include cardiovascular disease in 2017. Conclusions A community pharmacy has successfully sustained a disease management program for patients for over 14 years, demonstrating high patient enrollment, health outcomes at or near clinical guidelines for control, and positive financial outcomes associated with the program.
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Affiliation(s)
- Tammy Lopez
- City Employee Pharmacy, Colorado Springs; Maxor National Pharmacy Services, LLC
| | - Wesley Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
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Shetty KD, Chen AY, Rose AJ, Liu HH. Effect of the ExactCare medication care management model on adherence, health care utilization, and costs. J Manag Care Spec Pharm 2021; 27:574-585. [PMID: 33560167 PMCID: PMC10394188 DOI: 10.18553/jmcp.2021.20431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Multimorbidity and polypharmacy are common in the United States and are associated with greater risk of disease-related complications and higher health care costs. ExactCare has implemented a high-touch approach that includes home visits, comprehensive ongoing medication reviews, patient education, medication reconciliation, medication compliance packaging, and electronic reminders and trackers. OBJECTIVE: To test whether the ExactCare program improves medication adherence and reduces health care utilization and costs. METHODS: Using a national database from a large U.S. insurer, we identified Medicare Advantage plan members in 8 states from 2007 to 2018 who had both medical and prescription drug coverage. The index year for an ExactCare patient was identified using the date of the first prescription filled by ExactCare, with the previous year being the baseline. All patients without a prescription from an ExactCare pharmacy were considered potential comparison patients. To propensity match ExactCare and comparison patients, the probability of ExactCare participation was modeled using a logistic regression based on demographics, state, year, urban status, Medicaid eligibility, low-income subsidies, comorbidities, and baseline utilization and costs. Multivariate regression analysis was conducted to generate a difference-in-differences estimate of program effect for the matched pairs as well as patient-level fixed effects, while adjusting for additional time-varying characteristics. Adherence outcomes included the proportion of days covered for oral diabetic medications, antihypertensives, and hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins). Utilization outcomes included emergency department (ED) visits, hospitalizations, and skilled nursing facility (SNF) admissions, hospitalization days, and SNF days. Cost outcomes included total cost of care, prescription drug cost, hospital inpatient cost, and SNF cost. RESULTS: ExactCare patients (N = 701) were propensity-matched to comparison patients (N = 1,395) using the nearest 1:2 match approach, with an average follow-up period of 6.6 and 5.4 years for ExactCare and comparison patients, respectively. One year of ExactCare participation was associated with statistically significant increases in adherence to statins (8.4 percentage points; P < 0.001) and antihypertensive drugs (4.9 percentage points; P < 0.001), but the increase in adherence for diabetes drugs was not statistically significant. ExactCare participation was associated with statistically significant decreases in SNF admission rates (-67 SNF stays per 1,000 member-years; P = 0.011), inpatient days (-857 days per 1,000 member-years; P = 0.022), and SNF days (-1,801 days per 1,000 member-years; P = 0.002), but not with the rates of ED visits or hospital admissions. Each year of ExactCare participation was associated with increases in prescription drug costs ($30 per-member per month [PMPM]; P = 0.006) and decreases in total costs (-$196 PMPM; P = 0.023) and medical costs (-$226 PMPM; P = 0.008), largely attributable to decreases in hospital inpatient costs (-$119 PMPM; P = 0.001) and SNF costs (-$30 PMPM; P = 0.007). CONCLUSIONS: ExactCare's medication care management model was associated with improved medication adherence and an approximately $2,400 per member per year reduction in total cost of care, representing a 5% reduction in average costs. DISCLOSURES: This study was funded by ExactCare Pharmacy under a contract with RAND that grants the study authors sole responsibility for data management, study design, data analysis, manuscript drafting, and the decision to publish. The sponsor had no role in the study design and manuscript drafting. All data analysis was conducted by the study authors. A draft manuscript was reviewed by the sponsor, but the study authors made final decisions regarding the content and study conclusions. Shetty, Chen, and Liu are employed by RAND. Rose has nothing to disclose.
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Affiliation(s)
| | | | - Adam J Rose
- Hebrew University School of Public Health, Jerusalem, Israel
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Sousa MDCVB, Fernandes BD, Foppa AA, Almeida PHRF, Mendonça SDAM, Chemello C. Tools to prioritize outpatients for pharmaceutical service: A scoping review. Res Social Adm Pharm 2020; 16:1645-1657. [DOI: 10.1016/j.sapharm.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 01/16/2023]
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Abrahamsen B, Hansen RN, Rossing C. For which patient subgroups are there positive outcomes from a medication review? A systematic review. Pharm Pract (Granada) 2020; 18:1976. [PMID: 33224322 PMCID: PMC7672485 DOI: 10.18549/pharmpract.2020.4.1976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background: A medication review is a possibility to assess and optimise a
patient’s medicine. A model that includes a medication review and a
follow-up seem to provide the best results. However, it is not known whether
specific subgroups of patients benefit more from a medication review than
others. Objective: This literature review summarises the evidence that is available on which
patient subgroups exist positive outcomes from a medication review carried
out in a primary care setting. Methods: We performed a PICO analysis to identify keywords for setting, medication
review and effect. We then conducted a search using the PubMed database
(2004 to 2019) to identify studies relevant for our investigation. A
screening process was carried out based on either title or abstract, and any
study that matched the aim and inclusion criteria was included. All matching
studies were obtained and read, and were included if they met predefined
criteria such as study design, medication review and primary care. The
studies were divided into subgroups. First, each subgroup was divided
according to the studies’ own definition. Secondly, each subgroup was
allocated as either risk patients if the subgroup described a specific
patient subgroup or risk medication, if the subgroup was defined as using a
specific type of medication. This was done after discussion in the author
group. Results: 28 studies from a total of 935 studies were included. Identified studies were
divided into either risk patients; frail, recently discharged or multimorbid
patients, or risk medication; heart medication, antithrombotic medication,
blood pressure lowering medication, antidiabetic medication, anti-Parkinson
medication or medication increasing the risk of falls. The subgroups
identified from a medication review in primary care were defined as being
frail, recently discharged from hospital or multimorbid (risk patients), or
defined as patients using anticoagulant or blood pressure lowering
medication (risk medication). Most of the medication reviews in the studies
that showed an economic effect included at least one follow-up and were
delivered by a pharmacist. Conclusions: The literature review demonstrates that medication reviews delivered by
pharmacists to specific subgroups of patients are a way of optimising the
economic effect of medication reviews in primary care. This is obtained by
reducing health-related costs or the number of contacts with primary or
secondary health care services.
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Affiliation(s)
- Bjarke Abrahamsen
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Rikke N Hansen
- MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Charlotte Rossing
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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Chou J, Pellegrin K, Cooke CE, Zarowitz B, Hanlon A, Lozano A, Brandt NJ. Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review. J Manag Care Spec Pharm 2020; 26:1276-1281. [PMID: 32996388 PMCID: PMC10391206 DOI: 10.18553/jmcp.2020.26.10.1276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, compared with non-Hispanic White beneficiaries, Hispanic and non-Hispanic Black beneficiaries are less likely to be eligible for MTM. However, there is limited evidence for socioeconomic and geographical characteristics of those who are eligible and receive MTM services. OBJECTIVE To describe the demographic, socioeconomic, and geographic characteristics of Medicare beneficiaries who received MTM services. METHODS As part of a previous study, a national survey evaluated a convenience sample of perspectives of Medicare beneficiaries on the MTM standardized format. The survey was distributed through Medicare Part D plans to beneficiaries receiving MTM services from 2017-2018. As part of the survey, respondents could provide their ZIP codes. Geographical variables, such as the National Center for Health Statistics (NCHS) urban-rural classification scheme and economic research service (ERS) county typology codes, were then applied to respondents' ZIP codes, allowing for the classification of counties or census tracts by urbanization and economic dependence measures. Descriptive statistics are reported for demographic, geographical, and socioeconomic information. RESULTS Of the 300 (of 434) respondents who provided their ZIP codes, 51.3% were aged 65-74 years; 50% were male; and 66.7% had at least a college education. There were 82.7% who self-identified as White, while only 8% self-identified as Hispanic or Black/African American. The majority of respondents (58.4%) lived in large metropolitan areas as defined by the NCHS urban-rural classification scheme. Respondents' counties were characterized by economic dependence with 14.0% of respondents living in federal/state government-dependent counties and 12.7% living in recreation-dependent counties. CONCLUSIONS The majority of respondents who provided their ZIP codes identified themselves as White and lived in large metropolitan areas. Respondents who identified themselves as Hispanic or Black/African American were not well represented. This study provides geographical and socioeconomic characteristics of Medicare beneficiaries who received MTM services and highlights racial/ethnic differences. Further work is needed to confirm geographical and socioeconomic disparities among beneficiaries who received MTM services. DISCLOSURES No outside funding supported this study. Pellegrin is a member of the AMCP MTM Advisory Group. The other authors have nothing to disclose.
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Affiliation(s)
- Joshua Chou
- University of Maryland School of Pharmacy, Baltimore
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Patterns and predictors of older adult Medicare Part D beneficiaries' receipt of medication therapy management. Res Social Adm Pharm 2020; 16:1208-1214. [PMID: 31859225 PMCID: PMC9827433 DOI: 10.1016/j.sapharm.2019.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Medicare Part D medication therapy management (MTM) includes an annual comprehensive medication review (CMR) as a strategy to mitigate suboptimal medication use in older adults. OBJECTIVES To describe the characteristics of Medicare beneficiaries who were eligible, offered, and received a CMR in 2013 and 2014 and identify potential disparities. METHODS This nationally representative cross-sectional study used a 20% random sample of Medicare Part A, B, and D data linked with Part D MTM files. A total of 5,487,343 and 5,822,188 continuously enrolled beneficiaries were included in 2013 and 2014, respectively. CMR use was examined among a subset of 620,164 and 669,254 of these beneficiaries enrolled in the MTM program in 2013 and 2014. Main measures were MTM eligibility, CMR offer, and CMR receipt. The Andersen Behavioral Model of Health Services Use informed covariates selected. RESULTS In 2013 and 2014, 505,658 (82%) and 649,201 (97%) MTM eligible beneficiaries were offered a CMR, respectively. Among those, CMR receipt increased from 81,089 (16%) in 2013 to 119,181 (18%) in 2014. The mean age of CMR recipients was 75 years (±7) and the majority were women, White, and without low-income status. In 2014, lower odds of CMR receipt were associated with increasing age (adjusted odds ratio (OR) = 0.99 (95% confidence interval (CI) = 0.994-0.995), male sex (OR = 0.93, 95% CI = 0.926-0.951), being any non-White race/ethnicity except Black, dual-Medicaid status (OR = 0.64, 95% CI = 0.626-0.650), having a hospitalization (OR = 0.87, 95% CI = 0.839-0.893) or emergency department visit (OR = 0.67, 95% CI = 0.658-0.686), and number of comorbidities (OR = 0.90, 95% CI = 0.896-0.905). CONCLUSIONS CMR offers and completion rates have increased, but disparities in CMR receipt by age, sex, race, and dual-Medicaid status were evident. Changes to MTM targeting criteria and CMR offer strategies may be warranted to address disparities.
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Draime JA, Wicker EC, Krauss ZJ, Sweeney JL, Anderson DC. Description of Position Ads for Pharmacy Technicians. PHARMACY 2020; 8:E88. [PMID: 32456092 PMCID: PMC7356823 DOI: 10.3390/pharmacy8020088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/03/2022] Open
Abstract
Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician's role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database from Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians. A retrospective analysis was performed on fourteen days of pharmacy technician job listings from Pharmacy Week from the year 2018. Information obtained from the listings included job title, location, setting, type of job, job duties, and job requirements. Job duties and requirements were coded by themes. Fourteen days of data resulted in 21,007 individual position listings. A majority of the job listings were for full-time positions (96.4%) and most were in the retail setting (96.78%). The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism. This study provides a description of the evolving role of pharmacy technicians through the broad variety in expectations for requirements of pharmacy technician applicants and the duties they perform when hired.
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Affiliation(s)
- Juanita A. Draime
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH 45413, USA;
| | - Emily C. Wicker
- Cedarville University School of Pharmacy, Cedarville, OH 45413, USA; (E.C.W.); (Z.J.K.); (J.L.S.)
| | - Zachary J. Krauss
- Cedarville University School of Pharmacy, Cedarville, OH 45413, USA; (E.C.W.); (Z.J.K.); (J.L.S.)
| | - Joel L. Sweeney
- Cedarville University School of Pharmacy, Cedarville, OH 45413, USA; (E.C.W.); (Z.J.K.); (J.L.S.)
| | - Douglas C. Anderson
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH 45413, USA;
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Talon B, Perez A, Yan C, Alobaidi A, Zhang KH, Schultz BG, Suda KJ, Touchette DR. Economic evaluations of clinical pharmacy services in the United States: 2011-2017. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Brian Talon
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Alexandra Perez
- Department of Sociobehavioral and Administrative Pharmacy; Nova Southeastern University; Fort Lauderdale Florida
| | - Connie Yan
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Ali Alobaidi
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Katherine H. Zhang
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Bob G. Schultz
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Daniel R. Touchette
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
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Hawley CE, Triantafylidis LK, Paik JM. The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model. J Am Pharm Assoc (2003) 2019; 59:727-735. [PMID: 31231002 PMCID: PMC8150925 DOI: 10.1016/j.japh.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To embed pharmacy residents in an interprofessional nephrology clinic to conduct medication reconciliation in targeted high-risk patients with nondialysis kidney disease. SETTING This pilot was a prospective quality improvement initiative conducted in an interprofessional outpatient nephrology clinic. PRACTICE DESCRIPTION The nephrology clinic team includes nephrology providers, a social worker, and a geriatrician. The team is responsible for the management of conditions such as nondialysis kidney disease, resistant hypertension, acute kidney injury, proteinuria, and nephropathy. EVALUATION Primary outcomes included the number and type of medication discrepancies and drug therapy problems identified. Secondary outcomes included the changes in care process directly resulting from the pharmacy residents' recommendations. The perceived value of the pharmacy residents to the interprofessional team was assessed through postintervention anonymous surveys and semistructured interviews. RESULTS The pharmacy residents conducted 118 visits for 87 unique patients (mean age 73 years, 97% male) with nondialysis kidney disease (89% stages III-V), polypharmacy (87% of patients taking > 10 medications), and a heavy comorbidity burden (85% hypertension, 80% dyslipidemia, 59% diabetes mellitus type II) from January to October 2017. Pharmacists identified 344 medication discrepancies and 301 drug therapy problems, resulting in 398 changes in care process. The most frequently identified discrepancies and drug therapy problems were the omission of an active medication from the medication list (86 of 344 discrepancies, 25%) and potentially inappropriate medications (106 of 301 drug therapy problems, 35%). Pharmacists recommended 228 medication changes, provided 76 adherence devices, facilitated 24 consults or referrals, and communicated with the primary care team on 70 occasions. The interprofessional team members all strongly agreed that patients and the team benefited from the pharmacists' involvement. CONCLUSION Pharmacy resident-led medication reconciliation resulted in the identification and resolution of medication discrepancies and drug therapy problems, leading to changes in the care process.
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Affiliation(s)
- Chelsea E. Hawley
- New England Geriatric Research, Education, and Clinical Center
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
| | | | - Julie M. Paik
- New England Geriatric Research, Education, and Clinical Center
- Renal Section, VA Boston Healthcare System
- Brigham and Women’s Hospital
- Department of Medicine, Harvard Medical School, Boston, MA
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14
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Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence. J Manag Care Spec Pharm 2019; 25:688-695. [PMID: 31134865 PMCID: PMC10397886 DOI: 10.18553/jmcp.2019.25.6.688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.
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Affiliation(s)
| | | | | | | | - Phil Schwab
- Humana Healthcare Research, Louisville, Kentucky
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15
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Qiao Y, Spivey CA, Wang J, Shih YCT, Wan JY, Kuhle J, Dagogo-Jack S, Cushman WC, Chisholm-Burns M. Predictive Value Positive of MTM Eligibility Criteria under MMA and ACA in Identifying Individuals with Medication Utilization Issues. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019; 9:393-401. [PMID: 30906425 DOI: 10.1111/jphs.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). Methods This is a retrospective analysis of Medicare database (2012-2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for MTM under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g., 74.96% for 2009 MMA, 73.51% for 2013 MMA, and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P<0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95% CI: 2.454-2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. Conclusions MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.
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Affiliation(s)
- Yanru Qiao
- Health Outcomes and Policy Research, Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, , ,
| | - Christina A Spivey
- Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 258, , ,
| | - Junling Wang
- Health Outcomes and Policy Research, Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, , ,
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center & Chief, Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030, , ,
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Suite 633, Memphis, TN 38163, , ,
| | - Julie Kuhle
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Suite 130, Alexandria, Virginia 22315, , ,
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism & Director, Clinical Research Center, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, , ,
| | - William C Cushman
- Department of Preventive Medicine and Medicine, University of Tennessee College of Medicine & Chief, Preventive Medicine Section, Veterans Affairs Medical Center, 1030 Jefferson Avenue, Room 5159, Memphis, TN 38104, , ,
| | - Marie Chisholm-Burns
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 264, Memphis, TN 38163, , ,
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16
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Jorgenson D, Landry E, Lysak K, Bhimji H. Impact of pharmacist-led medication assessments on medication costs. Can Pharm J (Ott) 2019; 152:23-27. [PMID: 30719194 DOI: 10.1177/1715163518815211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Derek Jorgenson
- College of Pharmacy and Nutrition (Jorgenson, Landry, Bhimji), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority (Lysak), Saskatoon, Saskatchewan
| | - Eric Landry
- College of Pharmacy and Nutrition (Jorgenson, Landry, Bhimji), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority (Lysak), Saskatoon, Saskatchewan
| | - Katherine Lysak
- College of Pharmacy and Nutrition (Jorgenson, Landry, Bhimji), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority (Lysak), Saskatoon, Saskatchewan
| | - Hishaam Bhimji
- College of Pharmacy and Nutrition (Jorgenson, Landry, Bhimji), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority (Lysak), Saskatoon, Saskatchewan
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17
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Han N, Han SH, Chu H, Kim J, Rhew KY, Yoon JH, Je NK, Rhie SJ, Ji E, Lee E, Kim YS, Oh JM. Service design oriented multidisciplinary collaborative team care service model development for resolving drug related problems. PLoS One 2018; 13:e0201705. [PMID: 30265678 PMCID: PMC6161845 DOI: 10.1371/journal.pone.0201705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/20/2018] [Indexed: 11/29/2022] Open
Abstract
Our goal was to help prevent drug-related morbidity and mortality by developing a collaborative multidisciplinary team care (MTC) service model using a service design framework that addressed the unmet needs and perspectives of diverse stakeholders. Our service model was based on a “4D” framework that included Discover, Define, Design, and Develop phases. In the “discover” phase, we conducted desk research and field research of stakeholders to identify the unmet needs in existing patient care services. We used service design tools, including service safaris, user shadowing, and customer journey maps to identify pain and opportunity points in the current services. We also performed focus group discussions and in-depth interviews with stakeholders to explore the needs for improved services. In the “define” phase, we generated the service concept by mind mapping and brainstorming about the needs of stakeholders. The service concept was defined to be a Patient-oriented, Collaborative, Advanced, Renovated, and Excellent (P-CARE) service. We named the service “DrugTEAM” (Drug Therapy Evaluation And Management). In the “design” phase, we designed and refined four prototypes based on results from validation tests for their application towards following services: 1) medication reconciliation, 2) medication evaluation and management, 3) evidence-based drug information, and 4) pharmaceutical care transition services. During the “develop” phase, we implemented four services in a longitudinal chronic care model, considering the time spent by patients for each inpatient and outpatient setting. In conclusion, this is a study to develop a collaborative MTC service model using service design framework, focused on managing the unmet needs of patients and healthcare providers. As a result of implementing this service model, we expect to strengthen the professional relationship between pharmacists and stakeholders to ultimately create better patient outcomes.
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Affiliation(s)
- Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seung Hee Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyuneun Chu
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Jaehyun Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Ki Yon Rhew
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
| | - Jeong-Hyun Yoon
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Sandy Jeong Rhie
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Republic of Korea
| | - Eunhee Ji
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Euni Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yon Su Kim
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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18
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Fernandez-Lazaro CI, Adams DP, Fernandez-Lazaro D, Garcia-González JM, Caballero-Garcia A, Miron-Canelo JA. Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm 2018; 15:744-753. [PMID: 30241872 DOI: 10.1016/j.sapharm.2018.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States. OBJECTIVE To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease. METHODS A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence. RESULTS A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59). CONCLUSIONS Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain; Department of Health Sciences, Armstrong State University, 11935 Abercorn St, Savannah, GA, 31419, USA.
| | - David P Adams
- Department of General Studies, Point University-Savannah Campus, 55 Al Henderson Blvd, Savannah, GA, 31419, USA
| | - Diego Fernandez-Lazaro
- Department of Biochemistry and Physiology, School of Physical Therapy, University of Valladolid, Campus Duques de Soria, 42003, Soria, Spain.
| | - Juan M Garcia-González
- Department of Sociology, Pablo de Olavide University, Ctra. de Utrera, 1, 41013, Sevilla, Spain.
| | - Alberto Caballero-Garcia
- Department of Anatomy, School of Physiotherapy, University of Valladolid, Campus Duques de Soria, 42004, Soria, Spain.
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain.
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Corsi K, Lemay V, Orr KK, Cohen L. Pharmacist medication therapy management in home health care: Investigation of a sustainable practice model. J Am Pharm Assoc (2003) 2018; 58:S64-S68. [PMID: 29887258 DOI: 10.1016/j.japh.2018.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to quantify the financial impact of a pharmacist-driven pilot medication therapy management (MTM) program within a visiting nurse service (VNS) and identify types of medication-related problems affecting the home health care population. METHODS Patients were contacted to schedule a home visit with the primary investigator. At the appointment, a comprehensive medication review (CMR) was completed, and data collected included primary reason for VNS care, comorbid diagnoses, number of prescription and nonprescription medications at time of visit, and type of pharmacist-identified medication therapy intervention(s). The VNS is a nonprofit independent home health care agency serving patients of all ages and health conditions. Patients admitted with primary insurance coverage through Blue Cross Blue Shield (BCBSRI) Blue Chip for Medicare and 65 years of age and older were eligible for inclusion. Intervention categories were aligned to coordinate with current billable OutcomesMTM claim categories. Dollar allocation for each intervention severity level was assigned according to the predetermined Medicare cost savings predicted value from BCBSRI. Interventions were assigned cost-saving value by the severity level to estimate savings. RESULTS Twenty-five patients received CMRs. Patients averaged 5.92 chronic health conditions, 8.48 Part D drugs, and 3.88 over-the-counter medications. Two hundred eighteen medication-related problems were identified spanning 13 intervention categories. Intervention severity level was assigned to the medication-related problems, with calculated cost savings from pharmacist interventions totaling $124,352. CONCLUSION This pilot study demonstrated the positive economic impact of a pharmacist-run MTM program at VNS for patients with multiple chronic conditions and medication-related problems. Potential societal benefits include that community members admitted to VNS will continue to have access to a pharmacist as a standard of care with the continuation of this MTM program.
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20
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Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, Holstad MM, Essien EJ, Fleming M. A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. J Manag Care Spec Pharm 2018; 23:549-560. [PMID: 28448784 PMCID: PMC10398180 DOI: 10.18553/jmcp.2017.23.5.549] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence. OBJECTIVE To examine the effect of an MI telephone intervention conducted by pharmacy students in improving adherence to ACEIs/ARBs among Medicare Advantage Plan (MAP) patients with both DM and HTN. METHODS A prospective study was conducted among patients enrolled in a Texas MAP. Medical claims data were used to identify patients with DM and HTN, and pharmacy claims were observed to recognize those who filled either an ACEI or an ARB during June 2014. Patients with a 6-month proportion of days covered (PDC) < 0.80 in the previous 6 months were determined nonadherent, and 75% of those were randomly selected to serve as potential subjects for the intervention, while 25% were randomly selected to serve as potential subjects for the control group. The intervention was a telephone call by a pharmacy student on rotation at the health plan, and 5 monthly follow-up calls. Before implementing calls, participating students attended a 3-day MI training course, where their proficiency for MI skills was evaluated. Refill data during the 6-month postintervention were evaluated to examine the intervention effect measured on 3 outcomes: PDC; PDC ≥ 0.80 versus < 0.80; and discontinuation versus continuation. Multivariate linear and logistic regression models were constructed to adjust for any imbalances in baseline characteristics, including age, gender, number of other medications, regimen complexity, health low-income subsidy status, prescriber specialty, comorbidities, 6-month previous hospitalization, baseline 6-month PDC, and Centers for Medicare & Medicaid Services risk score. RESULTS A total of 11 students participated in the intervention implementation. Patients receiving calls were randomly selected from those potential subjects for the intervention arm until a target of 250 was reached; 500 controls were randomly selected from the potential subjects for the control arm. The final cohort included in multivariate models consisted of 743 patients. Patients completing the initial call and at least 2 follow-ups were less likely to discontinue (OR = 0.29; 95% CI = 0.15-0.54; P < 0.001) and more likely to be adherent in the linear regression model (β = 0.0604, P < 0.001) and the logistic regression model (OR = 1.53; 95% CI = 1.02-2.28; P = 0.009). Other factors significantly associated with better adherence included higher baseline PDC and number of medications. Depression status was significantly associated with lower adherence. CONCLUSIONS Patients receiving 2 or more calls had significantly better adherence and less discontinuation during the 6 months following initial calls compared with those who did not receive calls. This finding indicates that an MI-based telephone intervention by pharmacy students may be a promising intervention to improve adherence. Future research should examine the sustainability of the intervention effect for longer time periods and its influence on associated clinical outcomes. DISCLOSURES This project was supported by the Pharmaceutical Research and Manufacturers of America Foundation (PhRMA). The content is solely the responsibility of the authors and does not necessarily represent the official views of PhRMA. The funding agency was not involved in research design, analysis, or reporting results. Funding was obtained by Abughosh. Holstad provided a consultation regarding the MI guide and provided the MI training. Study concept and design were contributed by Abughosh and Fleming, along with Serna, Esse, and Holstad. Serna, Esse, Mann, Holstad, and Masilamani collected the data, and data interpretation was performed by Abughosh, Wong, and Esse. The manuscript was written by Abughosh, Wong, and Esse and revised by Masilamani and Holstad, along with the other authors.
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Affiliation(s)
- Susan Abughosh
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Xin Wang
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | | | - Tara Esse
- 2 Cigna-HealthSpring, Houston, Texas
| | | | - Santhi Masilamani
- 3 Nell Hodgson Woodruff School of Nursing and Clinical and Social Science Integration, Emory Center for AIDS Research, Emory University, Atlanta, Georgia
| | - Marcia McDonnell Holstad
- 3 Nell Hodgson Woodruff School of Nursing and Clinical and Social Science Integration, Emory Center for AIDS Research, Emory University, Atlanta, Georgia
| | - Ekere James Essien
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Marc Fleming
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
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21
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Vande Griend J, Fixen DR, Fixen CW, Zupec J, Saseen JJ. Clinic-Level Population Health Intervention by PGY2 Ambulatory Care Pharmacy Residents to Optimize Medication Management in a Self-Insured Employer Health Plan Population. J Pharm Pract 2017; 31:52-57. [PMID: 29278980 DOI: 10.1177/0897190017698057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postgraduate year 2 ambulatory care pharmacy residents (PGY2 residents) may be able to improve healthcare quality by providing clinical pharmacy services provided to self-insured employer health plan patients. The objectives of this study are to describe this care delivery in a family medicine clinic, and to identify patients most likely to benefit from the service. METHODS From October 1, 2014 till June 30, 2015, comprehensive medication review was completed by PGY2 residents for patients insured by CU Anthem at the University of Colorado Westminster Family Medicine. For patients with medication-related problems (MRPs), a note was sent to the provider before the patient visit. Patient characteristics were compared in those who received a clinical pharmacy note with those who did not. RESULTS Sixty-eight MRPs were identified in 39 notes; 40 (58.8%) recommendations were implemented. The following Clinical Pharmacy Priority (CP2) score criteria were identified more frequently in patients with MRPs: age ≥65 years, diagnosis of diabetes, hypertension, chronic obstructive pulmonary disease, cardiovascular disease, blood pressure ≥140/90, hemoglobin A1c >7.9%, and ≥6 items on the medication list. CONCLUSION PGY2 residents identified and resolved numerous clinically relevant MRPs. Patient-specific criteria can be utilized to target self-insured employer health plan patients who are likely to have clinically relevant MRPs.
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Affiliation(s)
- Joseph Vande Griend
- 1 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, CO, USA.,2 Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danielle R Fixen
- 1 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, CO, USA
| | - Cy W Fixen
- 3 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Jason Zupec
- 4 Department of Pharmacy Practice, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Joseph J Saseen
- 1 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, CO, USA.,2 Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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22
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Nuffer W, Gilliam E, Thompson M, Vande Griend J. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:36. [PMID: 28381896 PMCID: PMC5374925 DOI: 10.5688/ajpe81236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/03/2016] [Indexed: 05/30/2023]
Abstract
Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students' self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services.
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Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB. Coming full circle in the measurement of medication adherence: opportunities and implications for health care. Patient Prefer Adherence 2017; 11:1009-1017. [PMID: 28652710 PMCID: PMC5472434 DOI: 10.2147/ppa.s127131] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.
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Affiliation(s)
| | | | - Hayden B Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Larry Z Liu
- Center for Observational and Real World Evidence, Merck, Rahway, NJ and Weill Medical College of Cornell University, New York, NY
| | - Leah L Zullig
- Division of General Internal Medicine, Duke University School of Medicine
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System
| | - Bradi B Granger
- Duke University School of Nursing
- Heart Center Nursing Research Program, Duke University Health System, Durham, NC, USA
- Correspondence: Bradi B Granger, Heart Center Nursing Research Program, Duke University Health System, 307 Trent Drive, DUMC 3322 Durham, NC 27710, USA, Tel +1 919 684 1622, Email
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Park H, Adeyemi A, Wang W, Roane TE. Impact of a telephonic outreach program on medication adherence in Medicare Advantage Prescription Drug (MAPD) plan beneficiaries. J Am Pharm Assoc (2003) 2017; 57:62-66.e2. [DOI: 10.1016/j.japh.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023]
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Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, Chung N, Fleming M. A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm 2016; 22:63-73. [PMID: 27015053 PMCID: PMC10397653 DOI: 10.18553/jmcp.2016.22.1.63] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with comorbid hypertension (HTN) and diabetes mellitus (DM) are at a high risk of developing macrovascular and microvascular complications of DM. Controlling high blood pressure can greatly reduce these complications. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are recommended for patients with both DM and HTN by the American Diabetes Association guidelines, and their benefit and efficacy in reducing macrovascular and microvascular complications of DM have been well documented. Poor adherence, however, remains a significant barrier to achieving full effectiveness and optimal outcomes. OBJECTIVE To examine the effect of a brief pharmacist telephone intervention in identifying adherence barriers and improving adherence to ACEI/ARB medications among nonadherent patients with comorbid HTN and DM who are enrolled in a Medicare Advantage plan. METHODS Cigna-HealthSpring's medical claims data was used to identify patients with HTN and DM diagnoses by using ICD-9-CM codes 401 and 250, and at least 2 fills for ACEIs or ARBs between January 2013 and October 2013. Patients who failed to refill their medication for more than 1 day and had a proportion of days covered (PDC) < 0.8 were considered nonadherent and were contacted by a pharmacist by phone to identify adherence barriers. Two outcome variables were evaluated: The first was adherence to ACEIs/ARBs, defined as PDC during the 6 months following the phone call intervention. The second outcome variable was a categorical outcome of discontinuation versus continuation. Discontinuation was defined as not using ACEIs/ARBs during the 6-month post-intervention period. Patients who disenrolled from the plan in 2014 or were switched to another medication commonly used for treating DM and HTN were excluded from further analysis. Descriptive statistics were conducted to assess the frequency distribution of sample demographic characteristics at baseline. Multiple linear regression was conducted to assess the intervention effect on adherence during the 6 months post-intervention using the first outcome of post-intervention PDC, adjusting for baseline PDC and other covariates. Logistic regression was performed to assess the association between medication discontinuation and other baseline characteristics using the second outcome of discontinuation. Other control variables in the models included demographics (age, sex, language), physician specialty (primary care vs. specialist), health plan (low-income subsidy vs. other), Centers for Medicare & Medicaid risk score, Charlson Comorbidity Index, and number of distinct medications. RESULTS In total, 186 hypertensive diabetic patients, nonadherent to ACEIs/ARBs (PDC < 0.8), were included in the study. Of the 186 patients, 87 received the pharmacist phone call intervention. Among these patients, forgetfulness (25.29%) and doctor issues, such as having difficulty scheduling appointments (16.79%), were the most commonly reported barriers. After excluding those who switched from ACEIs/ARBs to another medication, 157 patients were included in the logistic regression model. Of those, 131 had continued using ACEIs/ARBs and were included in the linear regression model. The mean (±SD) post-intervention PDC for the intervention group was 0.58 (±0.26) and for the control group 0.29 (±0.17). Intervention was a significant predictor of better adherence in the linear regression model after adjusting all the other baseline covariates (β = 0.3182, 95% CI = 0.19-0.38, P < 0.001). Other covariates were not significantly associated with better adherence. In the logistic regression model (discontinuation: 26 [yes]/131 [no]) for predicting medication discontinuation, patients who received intervention were more likely to continue using ACEIs/ARBs (OR = 3.56, 95% CI = 1.06-11.86), and those with a higher comorbidity index were less likely to continue using them (OR = 0.72, 95% CI = 0.53-0.99). CONCLUSIONS The brief pharmacist telephone intervention resulted in significantly better PDCs during the 6 months following the intervention as well as lower discontinuation rates among a group of nonadherent patients with comorbid HTN and DM. The overall PDC rates in both the intervention and control groups were still lower than the recommended 80%. Improving adherence to clinically meaningful values may require more than a brief pharmacist phone call. Incorporating motivational interviewing techniques with follow-up calls to address adherence barriers may be more influential in forming sustainable behavioral change and enhancing medication adherence.
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Affiliation(s)
- Susan M Abughosh
- 1 Assistant Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Xin Wang
- 2 Graduate Student, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Omar Serna
- 3 Clinical Operations Director, Cigna-HealthSpring, Houston, Texas
| | - Chris Henges
- 4 Pharmacy Resident, Cigna-HealthSpring, Houston, Texas
| | - Santhi Masilamani
- 5 Clinical Assistant Professor, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Ekere James Essien
- 6 Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Nancy Chung
- 5 Clinical Assistant Professor, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Marc Fleming
- 1 Assistant Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
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McCarthy L, Su X(W, Crown N, Turple J, Brown TER, Walsh K, John J, Rochon P. Medication reconciliation interventions in ambulatory care: A scoping review. Am J Health Syst Pharm 2016; 73:1845-1857. [DOI: 10.2146/ajhp150916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - Jennifer Turple
- Institute for Safe Medication Practices Canada, Toronto, Canada
| | | | - Kate Walsh
- Toronto Central Community Care Access Centre, Toronto, Canada
| | - Jessica John
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Paula Rochon
- Women’s College Research Institute, Toronto, Canada
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Chisholm-Burns MA, Spivey CA, Tolley EA, Kaplan EK. Medication therapy management and adherence among US renal transplant recipients. Patient Prefer Adherence 2016; 10:703-9. [PMID: 27175070 PMCID: PMC4854272 DOI: 10.2147/ppa.s104646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients' (RTRs) immunosuppressant therapy (IST) adherence. This study's purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. METHODS Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. RESULTS In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02-1.26, P=0.02). CONCLUSION The findings provide evidence that access to MTM services increases IST adherence among RTRs.
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Affiliation(s)
- Marie A Chisholm-Burns
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - Christina A Spivey
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - Elizabeth A Tolley
- Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
| | - Erin K Kaplan
- Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
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Farris KB, Salgado TM, Aneese N, Marshall VD, Pendergast JF, Frank J, Chrischilles EA, Doucette WR. Effect of Clinical and Attitudinal Characteristics on Obtaining Comprehensive Medication Reviews. J Manag Care Spec Pharm 2016; 22:388-95. [PMID: 27023692 PMCID: PMC10397982 DOI: 10.18553/jmcp.2016.22.4.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Comprehensive medication reviews (CMRs) consist of in-depth reviews of patients' medications to identify effectiveness or safety problems and often generate cost savings for individuals. Despite their advantages, CMRs are not widely obtained. Previous studies found that older age, female sex, and experience of side effects were associated with obtaining a medication review. OBJECTIVE To quantify the association between attitudinal and clinical factors with intention and predict future behavior to obtain a CMR among Medicare Part D beneficiaries. METHODS A sample of Medicare Part D beneficiaries from 1 health care plan (n = 660) completed a 14-item survey over the telephone assessing factors that were hypothesized to affect their intention and behavior to obtain a CMR. The survey collected medication use history and health care information with the medication user self-evaluation tool, health status, adherence, intention to obtain a CMR, and demographic characteristics. Subjects subsequently were informed that they could obtain a CMR from their pharmacies. Claims data were obtained that indicated which subjects received a CMR. Two dependent variables were predicted: intention to schedule a CMR using a multivariate linear regression model and receipt of a CMR using a logistic regression and including intention as a predictor variable. RESULTS The mean age of participants was 76.6 (SD = 7.61) years; 71% were female; and participants took an average of 5.2 (SD = 3.18) medications. The intention to have a CMR was 2.85 (SD = 1.41) on a 5-point scale, and 5.6% of the participants actually had a CMR. Worrying about medications doing more harm than good, number of pharmacies where participants obtained their medications from, number of medications, and number of medical conditions predicted intention to obtain a CMR. Patients who perceived their health status to be poorer compared with others their age were more likely to have a CMR. Intention to obtain a CMR was not associated with receipt of a CMR. CONCLUSIONS Stakeholders should target patients who perceive their health to be poor for a CMR, hence expanding the scope of CMRs and increasing the number of older adults benefiting from this service. DISCLOSURES This study was funded by a grant from the Agency for Healthcare Research and Quality (1R18HS018353). Frank is an employee of Outcomes MTM. Pendergast has received grants from the NIH, NIA, and PICORI. Farris has received grants from NIH and speaker fees from Chulalongkorn University, Bangkok, Thailand, and the American College of Clinical Pharmacy. All other authors declare that they have no conflicts of interest. Study concept was developed by Farris, Pendergast, Chrischilles, and Doucette. Pendergast, Frank, Farris, and Aneese collected the data, with assistance from Chrischilles and Doucette. Data interpretation was performed by Farris, Marshall, Salgado, and Aneese, with assistance from the other authors. The manuscript was written by Farris, Salgado, and Aneese, with assistance from the other authors, and revised by Salgado and Marshall, assisted by the other authors.
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Affiliation(s)
- Karen B Farris
- 1 Charles R. Walgreen III Professor of Pharmacy Administration. University of Michigan College of Pharmacy, Ann Arbor
| | - Teresa M Salgado
- 2 Postdoctoral Research Fellow, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
| | - Nadia Aneese
- 3 Ambulatory Care Pharmacy Resident, Beaumont Health System, Troy, Michigan
| | - Vincent D Marshall
- 4 Statistician, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
| | - Jane F Pendergast
- 5 Professor of Biostatistics, Department of Biostatistics, University of Iowa College of Public Health, Iowa City
| | - Jessica Frank
- 6 Vice President of Quality, Outcomes MTM, West Des Moines, Iowa
| | - Elizabeth A Chrischilles
- 7 Professor and Marvin A. and Rose Lee Pomerantz Chair in Public Health, and Director, Health Effectiveness Research Center, University of Iowa College of Public Health, Iowa City
| | - William R Doucette
- 8 Professor and Head, Division of Health Services Research, Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City
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Mann A, Esse T, Abughosh SM, Serna O. Evaluating Pharmacist-Written Recommendations to Providers in a Medicare Advantage Plan: Factors Associated with Provider Acceptance. J Manag Care Spec Pharm 2016; 22:49-55. [PMID: 27015051 PMCID: PMC10398181 DOI: 10.18553/jmcp.2016.22.1.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pharmacist-written recommendation letters to physicians, through mail or fax, are common practice in managed care settings. While rates of physician acceptance of pharmacist recommendations have been reported to average around 50%, the factors affecting the provider's acceptance of recommendations have not been adequately explored. Identifying these factors may help to improve pharmacist-physician communication and help identify areas where physician education may benefit patient care. OBJECTIVES To (a) determine the percentage of pharmacist-written recommendations for members enrolled in a Medicare Advantage Plan with prescription drug coverage that was accepted by providers and (b) examine member and provider factors associated with provider acceptance. METHODS A retrospective cohort study was conducted among members enrolled in a Medicare Advantage Plan in Texas. Members were included if their medication profiles were reviewed by a health plan resident pharmacist and resulted in a recommendation letter sent directly to the member's provider between July 1, 2012, and March 15, 2014. Pharmacist-written recommendation letters were retrieved from the archived files and were assessed for factors such as type of recommendation made, the member's disease state affected by the recommendation, and the letter format. Other factors assessed included member and provider characteristics such as demographics, participation in the health plan pay-for-performance program, physician specialty, and region of practice. Acceptance was defined as a change in pharmacy claims that reflected the change suggested in the letter within 6 months of the recommendation. The percentage of recommendations accepted by providers was calculated. Chi-square tests were used to examine group differences in recommendation acceptances with recommendation type as well as member and prescriber characteristics. Logistic regression was used to identify significant predictors of an accepted change. RESULTS From 158 pharmacist-written recommendation letters, 228 recommendations were identified, of which 115 (50.4%) were accepted. Ninety-five (41.7%) recommendations were to add a drug; 80 (35.1%) recommendations were to discontinue a drug; and 53 (23.2%) recommendations were to change a drug. The member population affected by these recommendations had a mean [SD] age of 69 [± 11] years. Recommendations to discontinue or change a drug were more likely to be accepted than to add a drug (P = 0.007), but recommendation type was not determined as a significant predictor in the multivariate model. Recommendations for heart failure were less likely to be followed compared with recommendations for diabetes (OR = 0.31; 95% CI = 0.10-0.96; P = 0.043). A regional trend was identified in which recommendations in Southeast Texas were more likely to be implemented than those in West Texas, but it did not reach a level of significance (OR = 0.51; 95% CI = 0.24-1.07; P = 0.074), possibly because of the relatively limited sample size. CONCLUSIONS Overall, pharmacist-written recommendations were commonly accepted by physicians. Recommendations for heart failure were less likely followed versus those for diabetes. Since most recommendations for heart failure concerned changing drugs within the beta-blocker class, physicians may not have seen the value in modifying current therapy. This finding points to a potential need for physician education. Further research with larger samples is warranted to increase the power to identify significant differences in other variables that may need to be addressed in order to increase the rates of recommendation acceptance and improve patient care.
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Affiliation(s)
- Amanda Mann
- 1 Pharmacy Resident, Cigna-HealthSpring, Houston, Texas
| | - Tara Esse
- 2 Clinical Pharmacist, Cigna-HealthSpring, Houston, Texas
| | - Susan M Abughosh
- 3 Assistant Professor, University of Houston College of Pharmacy, Houston, Texas
| | - Omar Serna
- 4 Clinical Operations Director, Cigna-HealthSpring, Houston, Texas
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Conn VS, Ruppar TM, Chase JAD, Enriquez M, Cooper PS. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Curr Hypertens Rep 2016; 17:94. [PMID: 26560139 DOI: 10.1007/s11906-015-0606-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA.
| | - Todd M Ruppar
- School of Nursing, University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA
| | - Jo-Ana D Chase
- School of Nursing, University of Missouri, S343 Sinclair Building, Columbia, MO, 65211, USA
| | - Maithe Enriquez
- School of Nursing, University of Missouri, S327 Sinclair Building, Columbia, MO, 65211, USA
| | - Pamela S Cooper
- School of Nursing, University of Missouri, S318 Sinclair Building, Columbia, MO, 65211, USA
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Krass I. Quasi experimental designs in pharmacist intervention research. Int J Clin Pharm 2016; 38:647-54. [PMID: 26825756 DOI: 10.1007/s11096-016-0256-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Abstract
Background In the field of pharmacist intervention research it is often difficult to conform to the rigorous requirements of the "true experimental" models, especially the requirement of randomization. When randomization is not feasible, a practice based researcher can choose from a range of "quasi-experimental designs" i.e., non-randomised and at time non controlled. Objective The aim of this article was to provide an overview of quasi-experimental designs, discuss their strengths and weaknesses and to investigate their application in pharmacist intervention research over the previous decade. Results In the literature quasi experimental studies may be classified into five broad categories: quasi-experimental design without control groups; quasi-experimental design that use control groups with no pre-test; quasi-experimental design that use control groups and pre-tests; interrupted time series and stepped wedge designs. Quasi-experimental study design has consistently featured in the evolution of pharmacist intervention research. The most commonly applied of all quasi experimental designs in the practice based research literature are the one group pre-post-test design and the non-equivalent control group design i.e., (untreated control group with dependent pre-tests and post-tests) and have been used to test the impact of pharmacist interventions in general medications management as well as in specific disease states. Conclusion Quasi experimental studies have a role to play as proof of concept, in the pilot phases of interventions when testing different intervention components, especially in complex interventions. They serve to develop an understanding of possible intervention effects: while in isolation they yield weak evidence of clinical efficacy, taken collectively, they help build a body of evidence in support of the value of pharmacist interventions across different practice settings and countries. However, when a traditional RCT is not feasible for logistical and/or ethical reasons researchers should endeavour to use the more robust of the quasi experimental designs.
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Affiliation(s)
- Ines Krass
- Faculty of Pharmacy, A15, University of Sydney, Camperdown, NSW, 2006, Australia.
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Hayashi M, Yamatani A, Funaki H, Miyamoto K. Pharmacoeconomic effect of compliance with pharmacist's intervention based on cancer chemotherapy regimens: a cohort study. J Pharm Health Care Sci 2016; 1:10. [PMID: 26819721 PMCID: PMC4728767 DOI: 10.1186/s40780-014-0007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is important for pharmacists to manage cancer chemotherapy regimens in order to achieve safe treatment. We examined whether there was a useful pharmacoeconomic benefit of compliance the exclusion criteria of neutropenia, and the importance of a pharmacist's intervention was considered. METHODS A prospective observational cohort study was conducted at a community-based medical center. Among 374 patients who received chemotherapy between April 2010 and March 2011, 108 patients developed neutropenia and pharmacists recommended suspension of chemotherapy. These patients were divided into a group in whom chemotherapy was suspended (complying group) and a group in whom it was continued (non-complying group). Then the relative dose intensity (RDI) was compared between the two groups, and medical expenses related to the treatment of neutropenia (neutropenia-related costs: NRC) were compared. Analysis was carried out from the perspective of the health insurance provider, so only the direct medical costs were evaluated. RESULTS There was a significant difference of the RDI between a complying group (85.2 ± 10.0%) and a non-complying group (79.3 ± 15.0%) (P = 0.021). The average NRC per patient showed a significant difference between the two groups (complying group: 1,944 ± 412 dollars, non-complying group: 4,394 ± 837 dollars, P = 0.044). The economic effect over one year was 54,205 dollars. CONCLUSION The present findings suggest that ensuring compliance with chemotherapy regimens (including the criteria for neutropenia) is effective from a pharmacoeconomic perspective. Accordingly, pharmacists should intervene as required to improve regimen compliance.
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Affiliation(s)
- Makoto Hayashi
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan.,Department of Medicinal Informatics, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan
| | - Hiromu Funaki
- Department of Pharmacy, National Hospital Organization Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa 920-8650 Japan
| | - Kenichi Miyamoto
- Department of Medicinal Informatics, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
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Aguilar KM, Hou Q, Miller RM. Impact of Employer-Sponsored Onsite Pharmacy and Condition Management Programs on Medication Adherence. J Manag Care Spec Pharm 2015; 21:670-7. [PMID: 26233539 PMCID: PMC10397953 DOI: 10.18553/jmcp.2015.21.8.670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Poor medication adherence is associated with worsened health outcomes and higher health care expenditures. An increasing number of employers are sponsoring wellness initiatives designed to support healthy lifestyles, improve productivity, and offer a return on investment. Onsite pharmacies may facilitate higher medication adherence rates by providing employees a convenient, low-cost option for filling prescriptions that is integrated with other onsite health services. OBJECTIVES To (a) assess the impact of an employer's onsite pharmacy on health plan members' medication adherence using multiple measures of medication adherence and persistence, including medication possession ratio (MPR), average number of days until discontinuation (60-day gap in coverage), and percentage of members without a 30-day gap in coverage, and (b) evaluate these outcomes between those members who participated in condition management programs and those who did not. METHODS A retrospective analysis of a self-insured employer's claims data was undertaken. Medication adherence was assessed among the self-insured employer's health plan members, which included subscribers and their dependents who filled an asthma, depression, diabetes, hypertension, or hyperlipidemia medication at an onsite pharmacy, compared with those who used a community pharmacy. Multiple standard measures of medication adherence were considered. These measures included MPR, which was assessed for 1- and 2-year time periods. MPR was chosen because it is one of the most commonly referenced formulas in the literature and represents adherence over a fixed period of time. In addition, medication persistence was estimated by 30-day gaps in coverage and discontinuation of treatment. To assess the impact of onsite pharmacy use and account for covariate effects, the linear mixed model approach was applied with the logit transformed MPR as the response variable. An analysis of MPR among condition management participants was also performed. RESULTS In total, 2,498 subscribers and their dependents were included in the analysis. The average MPR at 365 days was significantly higher (P < 0.0001) among onsite pharmacy users for all medication types, ranging from 13% higher for depression medications to 20% higher for hypertension medications. This trend persisted at 730 days (P < 0.001), with average MPRs ranging from 6% higher for hyperlipidemia medications to 11% higher for hypertension medications. A mixed model analysis indicated that members who used the onsite pharmacy were 3.44 times more likely to demonstrate medication adherence (95% CI = 2.84-4.16; P < 0.0001) at 365 days. Likewise, at 180 and 365 days, onsite pharmacy users were less likely to have 30-day gaps in treatment. The average number of days until discontinuation (defined as a 60-day gap) was also significantly longer (P < 0.0001) among onsite pharmacy users, ranging from an average of 56 additional days for depression medications to 105 additional days for hypertension medications. While the average MPR tended to be higher among those subscribers and their dependents who participated in condition management programs, this trend was not statistically significant for all medication types. CONCLUSIONS Based on multiple measures, onsite pharmacy use was associated with higher medication adherence, while the results were inconclusive for condition management participation.
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Affiliation(s)
- Kathleen M Aguilar
- Cerner Research Consulting, 600 Corporate Pointe, Ste. 320, Culver City, CA 90230.
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Gatwood J, Balkrishnan R, Erickson SR, An LC, Piette JD, Farris KB. The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomized pilot study. Res Social Adm Pharm 2015; 12:130-140. [PMID: 25980582 DOI: 10.1016/j.sapharm.2015.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inadequate medication adherence reduces optimal health outcomes and can lead to increased costs, particularly in patients with diabetes. Efforts to improve adherence have resulted in limited effects; approaches leveraging mobile technology have emerged, but their focus has mainly been limited to simple reminder messages. OBJECTIVE The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes. METHODS Adults aged 21-64, with uncontrolled diabetes, and taking at least one anti-diabetic medication were recruited and randomized into 2 study arms: daily tailored text messaging for 90 days or standard care. Comparing baseline and endpoint survey responses, changes in theory-driven health beliefs and attitudes were assessed. The impact on medication adherence was evaluated using pharmacy claims by calculating the percent of days covered (PDC). RESULTS A total of 75 subjects were consented, and 48 were randomized. Mean PDC at baseline were comparable between cohorts (84.4% and 87.1%, respectively). Declines in adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period. Unadjusted tests suggested that perceived benefits and competence might have improved in the intervention arm. CONCLUSIONS Tailoring mobile phone text messages is a novel way to address medication nonadherence and health beliefs; further investigation to this combined technique is needed to better understand its impact on behavior change in adults with diabetes.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee, College of Pharmacy, Memphis, TN, USA.
| | | | | | - Lawrence C An
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Health Communication Research, Ann Arbor, MI, USA
| | - John D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, USA
| | - Karen B Farris
- University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
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Kuntz JL, Safford MM, Singh JA, Phansalkar S, Slight SP, Her QL, Lapointe NA, Mathews R, O'Brien E, Brinkman WB, Hommel K, Farmer KC, Klinger E, Maniam N, Sobko HJ, Bailey SC, Cho I, Rumptz MH, Vandermeer ML, Hornbrook MC. Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. PATIENT EDUCATION AND COUNSELING 2014; 97:310-26. [PMID: 25264309 PMCID: PMC5830099 DOI: 10.1016/j.pec.2014.08.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. METHODS We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. RESULTS We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. CONCLUSIONS We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. PRACTICE IMPLICATIONS Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
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Affiliation(s)
- Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
| | - Monika M Safford
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Jasvinder A Singh
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Shobha Phansalkar
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Sarah P Slight
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | | | | | | | | | - Kevin Hommel
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Kevin C Farmer
- The University of Oklahoma College of Pharmacy, Oklahoma City, USA
| | - Elissa Klinger
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | - Heather J Sobko
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Stacy C Bailey
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, USA
| | - Insook Cho
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Maureen H Rumptz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
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Schneiderhan ME, Shuster SM, Davey CS. Twelve-month prospective randomized study of pharmacists utilizing point-of-care testing for metabolic syndrome and related conditions in subjects prescribed antipsychotics. Prim Care Companion CNS Disord 2014; 16:14m01669. [PMID: 25667811 DOI: 10.4088/pcc.14m01669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Determine the percentage of subjects taking antipsychotics who meet criteria for metabolic syndrome based on point-of-care testing analyses. Evaluate pharmacist comprehensive medication management services using point-of-care tests to reduce the mean difference in number of metabolic syndrome risk parameters at 6 and 12 months. METHOD This 12-month, prospective, multisite, randomized, controlled study included 120 subjects taking antipsychotics (mean [SD] age of 42.9 [11.3] years) recruited from 3 community mental health clinics in Minnesota. Subjects consented to receive either pharmacist (PCS; n = 60) or no pharmacist (NCS; n = 60) comprehensive medication management services. Data were collected from February 2010 to January 2012. RESULTS No statistical differences in metabolic syndrome based on point-of-care tests were observed between the 2 groups at baseline (PCS: 85.2%, n = 46 versus NCS: 71.2%, n = 42, P = .073) or at 12 months (PCS: 84.4%, n = 38 versus NCS: 70.2%, n = 33, P = .104). Subjects, overall, screened positive at baseline for dyslipidemia (85.8%, n = 106), hypertension (52.5%, n = 63), and diabetes (22.5%, n = 27) based on point-of-care testing for metabolic risk criteria. After 12 months, a nonsignificant (P = .099) higher adjusted mean number of metabolic syndrome parameters in PCS subjects compared to NCS subjects (mean difference [95% CI] = 0.41 [-0.08 to 0.90]) were found. CONCLUSIONS A relatively high proportion of subjects met criteria for metabolic syndrome, although no significant improvement was observed between the groups after 12 months. Point-of-care test analyses identified a high proportion of subjects meeting criteria for dyslipidemia, hypertension, and diabetes. Utilizing point-of-care tests in mental health settings and fostering interprofessional partnerships with comprehensive medication management pharmacists may improve identification and long-term management of metabolic risks among patients prescribed antipsychotics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02029989.
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Affiliation(s)
- Mark E Schneiderhan
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Sara M Shuster
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Cynthia S Davey
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
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Park I, Sutherland SE, Ray L, Wilson CG. Financial implications of pharmacist-led Medicare annual wellness visits. J Am Pharm Assoc (2003) 2014; 54:435-40. [DOI: 10.1331/japha.2014.13234] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Anderson K, Willmore C, Doran E, Oki N, Vonnahme J, Gates BJ. Cognitive and Literacy Screening as Predictors of Ability to Fill a Pillbox Using Two Pillbox Assessment Scoring Methods. ACTA ACUST UNITED AC 2014; 29:304-16. [DOI: 10.4140/tcp.n.2014.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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St Peter WL, Wazny LD, Patel UD. New models of chronic kidney disease care including pharmacists: improving medication reconciliation and medication management. Curr Opin Nephrol Hypertens 2013; 22:656-62. [PMID: 24076556 PMCID: PMC4012859 DOI: 10.1097/mnh.0b013e328365b364] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Patients with chronic kidney disease (CKD) are complex, have many medication-related problems (MRPs) and high rates of medication nonadherence, and are less adherent to some medications than patients with higher levels of kidney function. Nonadherence in CKD patients increases the odds of uncontrolled hypertension, which can increase the risk of CKD progression. This review discusses reasons for gaps in medication-related care for CKD patients, pharmacy services to reduce these gaps and successful models that incorporate pharmacist care. RECENT FINDINGS Pharmacists are currently being trained to deliver patient-centred care, including identification and management of MRPs and helping patients overcome barriers to improve medication adherence. A growing body of evidence indicates that pharmacist services for CKD patients, including medication reconciliation and medication therapy management, positively affect clinical and cost outcomes, including lower rates of decline in glomerular filtration rates, reduced mortality and fewer hospitalizations and hospital days, but more robust research is needed. Team-based models including pharmacists exist today and are being studied in a wide range of innovative care and reimbursement models. SUMMARY Opportunities are growing to include pharmacists as integral members of CKD and dialysis healthcare teams to reduce MRPs, increase medication adherence and improve patient outcomes.
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Affiliation(s)
- Wendy L St Peter
- aChronic Disease Research Group, Minneapolis Medical Research Foundation bCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA cManitoba Renal Program dWinnipeg Regional Health Authority Pharmacy Program, Winnipeg, Manitoba, Canada eDepartment of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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