Abstract
The aim was to evaluate the impact of a multifaceted set of medication management interventions offered by a community pharmacy on adherence, health care utilization, and costs within a commercial population. Patients initiating therapy within 16 drug classes from February 7, 2013, to October 6, 2013, were offered various adherence interventions by Walgreens pharmacy. Patients were linked deterministically to IMS medical and prescription databases for 6-month pre- and post-index data analysis. Walgreens patients (intervention) were matched to patients using other pharmacies (control) on drug class, index date, baseline demographics, clinical factors, utilization, and costs. Outcomes were evaluated at the intent-to-treat level using post-index differences and generalized estimating equations (GEE) regression model. Paired t tests (continuous variables) and McNemar's test (dichotomous variables) were used to determine the significance of estimated model coefficients at α = 0.05. The groups (n = 72,410 each) had similar age (47.1 vs. 45.7 years), sex (41.2% vs. 40.2% male), and disease burden (0.52 vs. 0.40 mean Charlson comorbidity index). In the 6-month post-index period, the intervention group had 3.0% greater medication adherence, 1.8% fewer hospital admissions, 2.7% fewer emergency room (ER) visits, and 0.53 fewer mean outpatient visits compared to the control group (all P < 0.0001). The intervention group incurred significantly lower GEE-adjusted pharmacy costs (−$92), outpatient costs (−$120), ER costs (−$38), and total health care costs (−$226.07) (all P < 0.0001), and higher inpatient costs ($86, P < 0.004) per patient. A multifaceted set of medication management interventions offered by a community pharmacy were associated with patients in a commercial population having significantly higher medication adherence and lower health care utilization and costs.
Highlights
IntroductionNonadherence to medication is associated with increased hospitalization, progression of disease, and higher mortality.[1,2] only about 50% of patients with chronic conditions take their medications as prescribed.[3,4] Research has demonstrated that adherence can lead to lower health care utilization and total costs,[5,6] and is associated with better health outcomes and decreased risk of hospitalization.[6,7]Factors associated with nonadherence are complex and generally fall under the following categories: patient-related factors, health care system factors, condition-related factors, and therapy-related factors.[8,9] Patient-related factors can be subdivided into demographic, socioeconomic, cultural, and behavioral factors.[10]
In the 6-month post-index period, the intervention group had 3.0% greater medication adherence, 1.8% fewer hospital admissions, 2.7% fewer emergency room (ER) visits, and 0.53 fewer mean outpatient visits compared to the control group
A multifaceted set of medication management interventions offered by a community pharmacy were associated with patients in a commercial population having significantly higher medication adherence and lower health care utilization and costs
Summary
Nonadherence to medication is associated with increased hospitalization, progression of disease, and higher mortality.[1,2] only about 50% of patients with chronic conditions take their medications as prescribed.[3,4] Research has demonstrated that adherence can lead to lower health care utilization and total costs,[5,6] and is associated with better health outcomes and decreased risk of hospitalization.[6,7]Factors associated with nonadherence are complex and generally fall under the following categories: patient-related factors, health care system factors, condition-related factors, and therapy-related factors.[8,9] Patient-related factors can be subdivided into demographic, socioeconomic, cultural, and behavioral factors.[10]. The most commonly reported patientrelated reasons for nonadherence are forgetfulness and perception about side effects and drug efficacy[11]; for example, interventions that incorporate pharmacist counseling, patient education, and reminder systems have been shown to improve medication adherence.[1,12,13,14]
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