Appointment-based Medication Synchronization Research Articles

Health care resource utilization in Medicare beneficiaries obtaining medication synchronization

BackgroundAn appointment-based medication synchronization (ABMS) is a service whuch aligns patients’ chronic medications to a predetermined routine pickup date and includes a comprehensive medication review or other clinical appointment at the pharmacy. Objective(s)We compared healthcare utilization outcomes (outpatient, inpatient, emergency department visits, and pharmacy utilization) of Medicare beneficiaries enrolled in a med-sync program to beneficiaries not enrolled in such a program. MethodsThis retrospective cohort study included Medicare beneficiaries obtaining medications from pharmacies providing ABMS. All Medicare inpatient, outpatient, emergency, and pharmacy claims data from 2014 to 2016 obtained from the Research Data Assistance Center. These pharmacy claims were used to create med-sync (n = 13,193) and non–med-sync cohorts (n = 156,987). All patients were followed longitudinally for 12 months before and after a 2015 index or enrollment date. Baseline characteristics were used to create a logistic regression model for propensity score matching. A 1:1 greedy nearest neighbor matching algorithm was adapted for sequentially matching both cohorts. Difference in differences (DID) was used to compare mean changes in health care utilization outcomes (outpatient, inpatient, ED visits, and pharmacy utilization) between cohorts. ResultsAfter matching, 13,193 beneficiaries in each cohort were used for analysis. DIDs for mean of health care utilizations were statistically significantly lower in the med-sync cohort than the non–med-sync cohort for outpatient visits (DID 0.012, P = 0.0073) and pharmacy utilization (DID 0.013, P < 0.0001). There was not a statistically significant DID for inpatient and ED visits between cohorts. ConclusionOutpatient and pharmacy utilization changes were statistically significantly lower in the med-sync cohort than the non–med-sync cohort in the 12 months after enrollment. Lower pharmacy utilization could be caused by reducing duplicate prescriptions during synchronized refills or optimization of therapy during medication reviews if patients are enrolled in appointment-based model med-sync.

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

AbstractMedication synchronization (med‐sync) or appointment‐based medication synchronization (ABMS) programs allow patients to have their chronic medication refills aligned to one pickup day. For patients on multiple chronic medications, it provides a more manageable way of picking up those medications. The objective of the study was to systematically characterize literature describing economic and healthcare utilization, clinical, and humanistic outcomes for patients enrolled in med‐sync. A literature search was conducted on PubMed, International Pharmaceutical Abstracts (Ovid), CINAHL (EBSCO), EMBASE (Elsevier), and Cochrane Library. Studies were included if they were conducted at a pharmacy in the United States, between January 2008 and October 2022, and evaluated the impact of med‐sync on at least one of the four outcomes of interest (utilization, economic, clinical, and humanistic). The title and abstracts were screened, followed by a full‐text review and final data extraction by two researchers. A data extraction template and Cochrane risk of bias tool were used for data collection and quality assessments, respectively. The search resulted in 1617 studies and finally, 27 studies were included in the systematic review. All studies included patients enrolled in either ABMS, med‐sync, or in conjunction with other pharmacy services. Across all studies evaluating medication adherence, proportion of days covered (PDC) increased. All studies that administered patient surveys showed a majority of patients were satisfied with their med‐sync program. One study showed a reduction in healthcare utilization and costs, while another study indicated no change. Med‐sync programs have shown clinical outcomes, specifically to improve adherence in patients taking chronic medications. In terms of humanistic outcomes, patient surveys have shown high rates of satisfaction with med‐sync programs. Additional studies are needed to determine if med‐sync can lead to improvements in healthcare utilization and cost outcomes.

Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program.

The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.

Medication therapy problems and vaccine needs identified during initial appointment-based medication synchronization visits

ObjectiveTo characterize medication therapy problems (MTPs) and vaccines recommended and administered by pharmacists during initial appointment-based medication synchronization (ABMS) visits, in a community pharmacy setting. MethodsA retrospective observational study evaluated comprehensive medication reviews documented by pharmacists during initial ABMS visits in 16 supermarket chain pharmacies in Central Virginia from September to December 2017. The documentation was examined to obtain patient demographics, MTPs, and recommended and administered vaccines. Other data collected included disease states, number of medications synchronized per patient, and average time spent per initial ABMS visit. Classifications of MTPs were adherence (overuse and underuse), adverse drug reaction, cost-efficacy management, drug interactions (drug-drug/drug-disease), excessive dose/duration, needs additional therapy (for chronic conditions), suboptimal drug selection, and unnecessary therapy. Data were analyzed using descriptive statistics, and Wilcoxon-Mann-Whitney test was used to compare group differences. ResultsOne hundred eighty-four patients received an initial ABMS visit (118 female and 66 male patients). The mean age was 70 years for women and 65 years for men, range 18 to 19 years (P < 0.08). Disease states documented included asthma, benign prostatic hyperplasia, chronic pain, epilepsy, depression, diabetes mellitus, dementia, gastroesophageal reflux disease, history of myocardial infarction, human immunodeficiency virus, hyperlipidemia, and hypertension. Women had a significantly higher number of disease states than men did (P < 0.03). Thirty-seven MTPs were identified with no statistical difference between men and women (P < 0.98). Pharmacists reported spending an average of 17 minutes with patients during the initial visit for an average of 6 medications synchronized per patient. Six hundred thirty-three vaccines were recommended, and 51 were administered. ConclusionInitial ABMS visit with a comprehensive medication review facilitated pharmacists in detecting medication therapy problems. Although vaccines administered were lower than recommended, community pharmacists play an important role in preventive health through vaccine screenings and recommendations. Future plans include evaluating the outcomes of MTPs identified and resolved in the ABMS service.

Using Service Blueprints to Visualize Pharmacy Innovations.

Background: Applying the principles of service design can help pharmacists manage both the quality and patient perceptions of the services they provide. Service blueprints are a widely used service design tool that are rare in the healthcare literature. They can be used to design new services or revisit the design of established services. This paper describes service blueprints and their uses, and illustrates how to build one using an example. Methods: A blueprint is built for appointment-based medication synchronization services to illustrate the tool. Conclusions: Service blueprints permit pharmacists to better see and understand service processes. They clarify the process of service delivery and the roles of customers, service providers, and supporting services. They provide a way of depicting complex services in a concise visual way that communicates details at a glance. Pharmacists who utilize service blueprints can improve the consistency and quality of services provided, and they can increase the chance that every interaction with patients sends a positive message about the value of pharmacist services.

A Medication Synchronization Program and Blood Pressure Levels in a Community Pharmacy: Protocol.

BackgroundThe lack of adherence to prescribed antihypertensive medication occurs in 50% of patients and leads to poor health outcomes and increased medical costs. Consistent use of antihypertensive medications among patients with hypertension is essential to the reduction of short- and long-term cardiovascular complications. Strategies to improve medication adherence include syncing prescription medications in the pharmacy, which allow patients to retrieve chronically prescribed medications in one visit. The adoption of medication synchronization has been shown to improve adherence to medications; however, there is a lack of data showing if the intervention reduces blood pressure and improves long-term health outcomes.ObjectiveThis study aims to determine the association between participation in an appointment-based medication synchronization service and blood pressure levels among patients on antihypertensive medications.MethodsThis longitudinal prospective cohort study will observe changes in blood pressure among individuals in a medication synchronization program and those in a usual care group. Patients on at least two antihypertensive medications and four total medications have been recruited to participate in the study. All participants will be required to have at least a 6-month history of filling prescriptions at the pharmacy prior to enrollment in the study. Based on an estimated standard deviation of 14 mmHg, a sample size of 70 participants provides approximately 80% power with a two-sided .05 significance to detect a difference of 9 mmHg blood pressure between the two cohorts.ResultsAs of the publication of this paper, patients are completing final blood pressure visits at the pharmacy and medication data are being collected from the pharmacy. Once patients complete all blood pressure visits, data analysis will begin.ConclusionsThis study will link medication synchronization and changes in blood pressure levels among individuals with hypertension. This study will provide preliminary data for a randomized clinical trial that will assess the impact of medication synchronization on blood pressure.International Registered Report Identifier (IRRID)DERR1-10.2196/12527

Impact of Appointment-Based Medication Synchronization on Proportion of Days Covered for Chronic Medications

Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan’s Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.

The impact of appointment-based medication synchronization on medication taking behaviour and health outcomes: A systematic review.

Proactive synchronization of medication refills through an appointment-based model (ABM) is a community pharmacy-based intervention targeting adherence to medications. We aimed to systematically review evidence on the impact of the ABM on medication taking behaviour, health resource utilization, clinical outcomes and the preferences of patients and providers. We conducted a systematic literature search of MEDLINE and Scopus from database inception through 6 February 2017. Studies were included if they were original investigations evaluating the impact of the ABM on at least one outcome of interest and published in the peer-reviewed literature as a full-text manuscript in the English language. Outcomes included medication taking behaviour, clinical and economic outcomes, health resource utilization, and patient or provider satisfaction. Data were synthesized qualitatively. Five studies, mostly observational in design and with low risk of bias, were included. Objective measures of medication taking behaviour were consistently improved in patients enrolled in an ABM vs control, indicating an association between appointment-based medication synchronization with improved adherence and decreased likelihood of non-persistence. A single decision analysis indicates a cost savings over 1year associated with the appointment-based medication synchronization programme modelled, for hypertension, diabetes and hyperlipidaemia. Limited data regarding health resource utilization and clinical outcomes and patient or provider satisfaction exist and are currently inconclusive. The ABM provides a unique, patient-centred service to improve medication adherence amongst patients taking chronic medications while demonstrating a positive financial return on investment. Future research is needed to determine the impact of the ABM on final health outcomes.

The impact of an appointment-based medication synchronization programme on chronic medication adherence in an adult community pharmacy population.

Non-adherence to medication regimens is the primary cause of suboptimal clinical benefit in patients with chronic diseases. The primary objective of this study was to assess and compare adherence to chronic medications among adults participating in Time My Meds (TMM), an appointment-based medication synchronization programme, to patients receiving usual care. This was a quasi-experimental study that evaluated data from 18 partner community pharmacies in three lower U.S. Midwestern states between January 2013 and May 2015. During the 6-month post-period, PDC≥0.80 was achieved by 73.53%, 80.41% and 75.00% of usual care patients taking oral diabetes, renin-angiotensin system antagonist (RASA) and statin medications. In comparison, the PDC threshold was achieved by 100%, 97.94% and 97.62% of TMM patients taking oral diabetes, RASA and statin medications (P<.031 in diabetes group and P<.003 in RASA group). The percentage of on-time prescription refills increased from 69.68% to 84.75% in patients with diabetes, 79.04% to 89.56% in the hypertension group and 78.26% to 89.07% in the hyperlipidaemic group. An appointment-based medication synchronization programme in community pharmacies resulted in improved adherence and increased percentage of on-time refills.

Impact of Appointment-Based Medication Synchronization on Existing Users of Chronic Medications.

Appointment-based medication synchronization (ABMS) has been associated with greater patient adherence and persistence when patients begin taking chronic medications. It is not known whether similar results will be seen for patients who have been taking chronic medications for 6 months or more. To compare the impact of a community pharmacy chain's ABMS program on medication adherence and persistence of existing users of chronic medications with individuals who are not enrolled in the program. A retrospective cohort study compared patients receiving ABMS with matched comparison groups receiving usual care. ABMS consisted of synchronizing a patient's medications to be dispensed on a single appointment day every month, a call to the patient prior to the appointment day to address any prescription changes and to remind the patient, and a patient visit to the pharmacy to pick up the medications. Outcomes were 1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. Data for this study came from prescription claims records of patients taking 1 of 6 chronic medication classes during the period of December 1, 2011, to February 28, 2014. ABMS patients were matched with comparison groups according to prior adherence behavior, medication class, age, gender, and geographic region. Mean PDC scores ranged from 0.73 to 0.91 for ABMS patients (n = 205 to 716) and from 0.57 to 0.71 for usual care depending on the medication class. The percentage of adherent individuals (i.e., PDC ≥ 0.80) was 55% to 84% for ABMS participants and 37% to 62% for usual care. Odds of adherence was 2.3 to 3.6 times greater with ABMS. Usual care patients became nonpersistent (61% to 74%) more often than ABMS patients (33% to 44%) with hazard ratios of nonpersistence being 0.39 to 0.67 for individuals in the program. An ABMS program in a community pharmacy setting was associated with higher rates of adherence and persistence for patients who had been taking chronic medications for at least 6 months. Approximately 18 to 35 additional ABMS participants were adherent for every 100 patients enrolled when compared with usual care. For every 100 patients receiving usual care, 17 to 40 additional patients in the ABMS group were persistent. This study shows that ABMS programs can improve medication adherence and persistence for patients who are newly prescribed or currently taking chronic medications.

PHS74 - Impact of appointment-based Medication Synchronization on existing users of Chronic Medications

BACKGROUND: Appointment-based medication synchronization (ABMS) has been associated with greater patient adherence and persistence when patients begin taking chronic medications. It is not known wh...

Adherence and persistence associated with an appointment-based medication synchronization program

ObjectiveTo assess the impact of an appointment-based medication synchronization (ABMS) program on medication adherence and persistence with chronic medications. DesignQuasiexperimental study in which study patients were matched with control patients. SettingRural pharmacies in the Midwestern United States between June 30, 2011, and October 31, 2012. PatientsIndividuals receiving at least two refills for one of six categories of medications to treat chronic diseases (i.e., angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, dihydropyridine calcium channel blockers, thiazide diuretics, metformin, statins). InterventionPatients in the ABMS program were compared with control patients receiving usual care. Main outcome measures1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. ResultsDepending on the drug class, patients enrolled in the medication synchronization program (n = 47–81) had adherences rates of 66.1% to 75.5% during 1 year versus 37.0% to 40.8% among control patients. Program patients had 3.4 to 6.1 times greater odds of adherence compared with control patients. Control patients were 52% to 73% more likely to stop taking their chronic medications over 1 year. ConclusionAn ABMS program in community pharmacies was associated with improved patient adherence and reduced likelihood of nonpersistence.