Medication Synchronization Program 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.

Evaluation of a hybrid medication synchronization training module for pharmacy technicians

BackgroundMedication synchronization involves coordinating a patient’s medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared with automatic refill-processing programs. Patients are 2-6 times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. ObjectiveThis study aimed to develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. Practice descriptionAn independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. Practice innovationThe training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. Evaluation methodsTechnicians took a pre-training survey assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component regarding medication synchronization. Technicians took the same post-training survey 2 weeks after completing the training session and using medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t test. ResultsTen technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1 of 9 points), the mean post-training knowledge score was 92% (8.3 of 9 points), and the mean difference between the pre- and post-training knowledge scores was 13.4% (1.2 points), with a statistically significant difference (P = 0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale, and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. ConclusionThe standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

A retrospective review of the impact of immunization eCare plans in community-based pharmacy setting

BackgroundThe Pharmacist Electronic Care (eCare) plan is an electronic documentation and billing platform that allows for exchanging and integrating pharmacy patient care information. eCare plans make it easier for pharmacists to track recommendations and referrals to both patients and providers and to bill for services. ObjectivesTo determine the impact on the type and number of vaccines administered after the completion of immunization eCare plans and to examine sociodemographic differences in patients who received immunizations were documented in an eCare plan in a community-based pharmacy setting. Practice DescriptionBremo Pharmacy is an independently owned pharmacy located in Richmond, Virginia. Bremo Pharmacy offers a medication synchronization program targeting patients for enrollment in compliance packaging and clinical services. Practice InnovationBremo Pharmacists use eCare plans to track patient and provider interactions, goals, and medication-related information. Pharmacists used eCare plans to document vaccine recommendations and interactions with patients as a tool to increase vaccinations. Evaluation MethodsReports were generated to extract data containing information from each eCare plan during the intervention period and the number and type of vaccines administered 1 and 2 years before the intervention. Percent change was used to calculate the change in vaccines administered between years. The sociodemographic data was analyzed using descriptive statistics and bivariate statistical analysis using SAS 9.0 (Cary, NC). ResultsThere were a total of 1105 immunization eCare plans completed. An increase of 136.6% in vaccines administered occurred after the implementation of the eCare plans. While the number of vaccines administered increased, no significant differences were found in vaccine uptake by gender or age. ConclusionImmunization eCare plans are a useful tool to help pharmacists increase the number of vaccines administered in an independent pharmacy.

The impact of SyncPlus on workflow in an independent pharmacy

BackgroundMedication Synchronization (Med Sync) is a medication management strategy that aligns two or more medications to be refilled on the same date. Med Sync may improve several patient outcomes when implemented in a community pharmacy. SyncPlus is a Med Sync service developed at Crosby’s Drugs. Objectives for assessment of SyncPlus included evaluation of changes to delivery volume, number of delivered prescriptions, and number of medication therapy management interventions before and after SyncPlus implementation. Practice descriptionCrosby’s Drugs is an independent pharmacy in downtown Columbus, Ohio. The pharmacy offers several services to a largely Medicare-insured population. Practice innovationSyncPlus patients must fill all prescription medications at Crosby’s Drugs and take at least 5 chronic medications, excluding controlled substances and gabapentin. To enroll, patients verbally agree to review their profile with a technician. Patients complete a clinical consult with a pharmacist to address medication-related problems. Through shared decision-making, the patient and pharmacist determine an anchor drug and next fill date. Medications are short-filled as insurance coverage allows. Pharmacists and interns address medication-related problems and contact prescriber offices for refills and clarifications. Documentation and billing are conducted via the Outcomes platform. Evaluation methodsA 3-month retrospective chart review was performed before and after SyncPlus implementation. Internal pharmacy data and Outcomes data provided reports to address objectives. ResultsIn the three months after SyncPlus implementation, 10 patients were enrolled over three months. The sum of total deliveries dropped from 4478 to 3974. The number of prescriptions delivered were similar before and after SyncPlus implementation. During the 3 months post-implementation 89 Outcomes interventions were completed compared with 18 interventions in the three months prior. ConclusionsA medication synchronization program in an independent pharmacy may improve workflow efficiency by reducing deliveries and increasing opportunities for medication management for patients.

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.

P70 Evaluation of Cost and Health Utilization Outcomes of Medicare Beneficiaries Enrolled in a Medication Synchronization Program

Medication synchronization (med-sync) aligns patients’ chronic medications to a predetermined routine pickup date at a community pharmacy. An appointment-based model (ABM) med-sync service includes a comprehensive medication review or other clinical appointment at the pharmacy. We compared the cost and healthcare utilization outcomes of Medicare beneficiaries enrolled in an ABM med-sync program to beneficiaries not enrolled in such a program.

Evaluating the Effects of a Medication Adherence Packaging Program on Outcomes in Older People.

Objective To determine the impact of an adherence packaging and medication synchronization program on hospital visits for older people living independently in the community. Design A retrospective pre-post study that evaluated patient outcomes over a 24-month period was conducted. Patient-specific socio-demographic, medical, and hospital visit-related data were collected for 12 months before and after patient enrollment in the adherence packaging program. Setting The study was conducted at Rx Partners LTC, LLC, a University of Pittsburgh Medical Center (UPMC) pharmacy in Pittsburgh, Pennsylvania. Participants Patients 65 years of age or older, of any gender, with UPMC Health Plan insurance coverage, who enrolled in the adherence packaging program between July 2019 and December 2019. Intervention Enrollment in the adherence packaging program included medication synchronization and packaging in prefilled medication sets delivered to the patient's home monthly. Monthly medication reconciliation and review by clinical pharmacists was an included value-added service. Results Of the 92 patients included in the analysis, 60 had hospital visits during their pre-enrollment period for a total of 146 visits, compared with 54 patients in the postenrollment period totaling 126 visits; however, the mean rate of hospital visits was not statistically significant (1.59 versus 1.37; P = 0.48). Pharmacists prevented 1.87 medication errors/patient in the postenrollment setting. Conclusion Enrollment in the program was associated with fewer hospital visits, though not statistically significant, and pharmacists had abundant opportunity to prevent medication errors and optimize regimens. Further evaluation is warranted in a larger cohort.

Pilot Evaluation of Pharmacists’ and Pharmacy Technicians’ Knowledge and Understanding of a Medication Synchronization Program

Background: Medication synchronization (MS) improves adherence by allowing patients to pick up all medications at the same time. Pharmacy staff need training to utilize a MS program effectively. Objective: Evaluate the impact of a video tutorial with decreased extraneous and intrinsic load on pharmacists’ and pharmacy technicians’ knowledge and understanding of a MS program. Study Method: Participants completed a prequestionnaire to assess knowledge and understanding of the MS process. They then watched a step-by-step video tutorial and were reassessed by a postquestionnaire 2 weeks later. Study participants included pharmacists and pharmacy technicians employed at 1 of 2 pharmacies in 1 regional division of a large community-based chain pharmacy. Participants were eligible if they were registered and in good standing with the Kansas Board of Pharmacy and employed for greater than 30 days since July 1, 2018. Results: Twenty participants were included in the final analysis. The median age was 36 years, 14 (70%) were female, 13 (65%) were pharmacy technicians, and each study site had equal representation. Most participants, 15 (75%), had previously completed the standard MS training. There was a significant improvement in number of correct responses after the intervention with a prequestionnaire score of 61.3% to postquestionnaire score of 70% (P=.002). Significant improvement in knowledge was seen in participants who completed the previous training as well as first-time learners of the MS process. Conclusion: Optimizing training on MS processes by decreasing extraneous and intrinsic load improved the pharmacy team’s knowledge and understanding of the MS process.

A Review on Medication Synchronization Programs in Community Pharmacies to Improve Medication Adherence

Adherence to the prescribed medications plays an important role in treatment of chronic diseases.Hypertension, Ischemic heart diseases, Diabetes mellitus, Dyslipidaemia’s are major health challenges of21st Century and are more expensive. A total 79% of Projected deaths are caused due to chronic diseasesin developing countries. Non adherence to prescribed medications is one of major health threat worldwide.Patients who are on chronic diseases are offen visits multiple health care practioners, numerous pharmacies,and who take multiple drugs results in medication non-adherence. The new primary care models suggestthat there is no promotion of close physician-patient-pharmacist relationships. Training for the treatmentof chronic diseases is seldom satisfactory and there is inadequate consistency and communication betweenhealth care providers. Among health care profession community pharmacist are the ideal position to assistthe management of patients with chronic disease. The Synchronization services are offered by severalcommunity pharmacies to improve medication adherence. These programs work by overcoming the barriersof medication non adherence by refilling their prescription in their single visits. Although there are Numerousmedication synchronization programs are available in community pharmacies effectives of medicationsynchronization programs are confined to its type synchronization programs implemented.

Medication synchronization adoption and pharmacy performance.

While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance. The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures. This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered. Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c=5.4, p=0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p=0.371). Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients.

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.

Implementation of a community pharmacy workflow process to identify and follow up with prescription abandonment

ObjectivesTo describe a workflow process that uses members of the pharmacy staff to identify prescription abandonment and resolve barriers that contribute to medication nonadherence. SettingIndependent community pharmacy in the southeastern United States. Practice descriptionEach of the 6 Moose Pharmacy locations provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication reviews, disease state management programs, point-of-care testing, and compounding. Practice innovationA workflow process, including a conversation flowchart and will-call bag tag, were created to support prescription abandonment discussions. Patients were included if at least 1 refilled or newly authorized prescription was not picked up within 7 days of the medication being filled. Patients younger than 18 years and as-needed prescriptions were excluded. EvaluationDuring the 60-day study period, 73 patients met the criteria of having an abandoned prescription; 124 total prescriptions were identified as abandoned. The barriers to adherence identified with these patients were 32% forgotten, 18% cost, 11% transportation, 4% refusal, 16% other responses, and 19% of patients who were not able to be reached. After the process was completed, 56 patients (76.7%) received their medications. The average time to pick-up for subsequent successful contact was 3 days. Of the 73 patients, 15 (20.5%) were already enrolled in the medication synchronization program. With the use of a conversation flowchart, 2 additional patients were enrolled in the pharmacy’s medication adherence program and 8 others were enrolled in the automatic notification program when prescriptions are filled. ConclusionA workflow process such as the one used in this study can help to identify barriers contributing to prescription abandonment. Through this process, the pharmacy learned that educating all staff members regarding the workflow may help to expand interventions to curtail prescription abandonment and address medication adherence.

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 medication synchronization programs on proportion of days covered (PDC) scores and Medicare Part D medication-related adherence metrics

ObjectivesThis study aimed to determine if patients enrolled in a medication synchronization program have improvements in proportion of days covered (PDC) score for 3 of the Centers for Medicare and Medicaid Services adherence metrics medication classes: statins, renin-angiotensin-aldosterone system antagonists, and noninsulin diabetes medications. MethodsThis retrospective cohort study used data from members of a Medicare Advantage Prescription Drug plan, who took at least 1 of the key metric medications and had sufficient data to calculate a PDC score. The exposed cohort (“sync”) consisted of patients who enrolled in the medication synchronization program within the plan’s preferred pharmacy network, and the control group consisted of those who did not enroll in the program but met all other criteria. The primary end point was the change in PDC score from 2015 (baseline) to 2017 for each medication class. Secondary end points included the proportion of members with PDC scores of at least 85% and the association of adherence with annual medical and pharmacy costs. ResultsThe largest PDC score increases for the entire study population were seen in all 3 sync groups (RASA, diabetes, and statin) with corresponding statistically significant PDC score increases of 1.6%, 4.8%, and 2.9%, compared with −0.4%, 0.5%, and 1.3% changes in the control groups. In the multiple linear regression analysis, there were significant PDC score differences in the changes from baseline between the sync and control RASA, diabetes, and statin groups (P = 0.005, P = 0.01, and P < 0.001, respectively). The proportion of members achieving the acceptable PDC score threshold increased by 1.1% in the control group and by 4.1% in the sync group. ConclusionIn a population of patients with high baseline adherence, this medication synchronization program was associated with a statistically significant increase in adherence scores for statin, RASA, and noninsulin diabetes medications. There was no significant change in medical or pharmacy costs from the health plan perspective.

Systematic review of medication synchronization in community pharmacy practice.

Medication non-adherence costs more than 100 billion dollars in avoidable hospitalizations yearly. As a result, community pharmacies have implemented medication synchronization programs to improve adherence. One function of most medication synchronization programs is the alignment of all of a patient's medications to refill on a single date. While aligning refills is a standard aspect of most programs, other features vary making it difficult to identify which program components lead to improved adherence. To review available literature and identify core components of medication synchronization and associated implementation techniques in community pharmacy. A systematic review was performed by searching electronic databases for studies, reviews, and other sources for grey literature discussing medication synchronization in community pharmacy settings. Studies were eligible for inclusion if they documented the operation of medication synchronization program in a community pharmacy. A framework analysis identified common themes present in the literature. Twenty-six studies met criteria for final inclusion in this review. The majority of studies were retrospective cohorts, commentaries, and implementation guides. A wide variety of core components were included as part of medication synchronization program descriptions in the available literature. Several core components were identified as consistent throughout most of the published literature. These components were the identification and enrollment of patients, inclusion of a medication review and patient assessment, the alignment of refills, a formal process for preparation of medications, and the delivery of medications and other services. This review identified several common themes of medication synchronization in the literature, which could help standardize medication synchronization within community pharmacy and facilitate future research. Themes found in this review provide the foundation upon which a consensus definition of medication synchronization can be built.

Financial impact of patients enrolled in a medication adherence program at an independent community pharmacy

ObjectivesTo determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies. SettingFive independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies. Practice descriptionMoose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding. Practice innovationCertain CPESN pharmacies, including Moose Pharmacy, were attributed complex Medicare or Medicaid patients having at least 1 chronic medication and at least 80% of medications filled at a CPESN pharmacy. Patients were included if they were attributed to a study location and enrolled in the Moose Medication Adherence Program (MooseMAP) for more than 12 months. Patients were excluded if they were younger than 18 years of age or had less than 12 months of prescription fill data. Reviewed data included patient demographics, chronic and acute medications, immunizations, MooseMAP type, number of chronic medication prescribers, chronic medication class, payer, and patient health risk indicators. Yearly profit for prescriptions filled was determined per patient. Independent-samples t test was used to assess data. EvaluationYearly profit per prescription was $10.35 for combined chronic, acute, and immunization prescriptions, $10.57 for chronic prescriptions, $26.95 for acute prescriptions, and $27.69 for immunizations. Mean profit for strip packaging was $1561.82 per year compared with $1208.01 per year with bottles (P = 0.021). There was a positive correlation between profit and number of prescriptions filled per 12 months (r = 0.56; P < 0.001), number of medication classes (r = 0.27; P < 0.001), and higher-risk indicator scores (r = 0.21; P < 0.001). ConclusionEnrolling complex patients in a medication adherence program can benefit community pharmacies, particularly CPESN pharmacies, through chronic medication fills and yearly profit. Greater profit is generated when prescriptions are dispensed in strip packaging instead of bottles.

Relationship between medication synchronization and antiretroviral adherence

ObjectivesTo compare antiretroviral adherence (measured as the proportion of days covered [PDC]) and change in viral load in insured, HIV-infected, adult outpatients enrolled and not enrolled in a medication synchronization program. MethodsThis was a multicenter, retrospective, pilot cohort study. Fifty-eight insured, HIV-infected, outpatients at least 18 years of age receiving antiretroviral therapy (ART) for at least 3 months as of August 2015 were included. PDC, viral load, PDC dichotomized into adherent or nonadherent, and viral load dichotomized into detectable or undetectable were collected for each patient. Study data were compared in those with (enrolled) and without (not enrolled or control) medication synchronization. The study end points were analyzed between the 2 groups retrospectively after 3 months. ResultsPDC in patients undergoing medication synchronization was significantly higher than in control patients: mean ± SD 96 ± 9% versus 71 ± 27%, respectively (P < 0.0001). The medication synchronization group was also more likely to be adherent to ART than the control group (odds ratio 10.67, 95% confidence interval 2.63–43.31). In the medication synchronization group, 75.9% of patients had an undetectable baseline viral load, and 83.3% had an undetectable viral load at study completion. In the control group, 62.1% and 64.7% had an undetectable viral load at baseline and completion, respectively. No statistically significant change in viral load was observed between groups (P = 0.34). ConclusionIn insured, HIV-infected, adult outpatients, implementation of a medication synchronization program was associated with improved ART adherence. Future studies are needed to better assess the impact of medication synchronization on clinical outcomes.

Evaluation of community pharmacist–provided telephone interventions to improve adherence to hypertension and diabetes medications

ObjectivesTo 1) identify specific patient barriers and pharmacist interventions to medication adherence by means of the Drug Adherence Work-Up (DRAW) tool; and 2) measure patient adherence to antihypertensive and antidiabetic medications by calculating proportion of days covered (PDC) before and after pharmacist telephone adherence interview. DesignThis prospective quality-improvement study consisted of telephonic interviews and targeted interventions to increase medication adherence based on patient-specific barriers. The baseline PDC was electronically calculated for each patient, and postintervention PDCs were manually calculated at 90 days and 180 days after baseline. The measurement period in each PDC calculation was 180 days. Setting and patientsThis study was conducted in a small-chain independent pharmacy in rural Midwest United States. Patients taking an antihypertensive or oral antidiabetic medication were identified through an online platform and contacted if they had a PDC of less than 80% during the previous 180 days. Outcome measuresBaseline and postinterview PDC were calculated for each patient who received an adherence interview. Frequency of specific barriers and pharmacist interventions were identified and analyzed. ResultsNinety-seven eligible patients were identified. Fifty-six patients participated in an interview. Of these, a total of 66 barriers to adherence were identified. Pharmacists implemented 76 interventions for these patients, and 43 patients were included in final PDC calculations. From baseline, 69.0% of patients with hypertension and 64.3% of patients with diabetes reached a PDC of greater than 80% within 3 months. The most frequently identified barrier was forgetfulness on routine days, and the most common interventions were patient education, deactivated drug, and recommend or start medication synchronization program. ConclusionUsing pharmacists to identify and address patient barriers to adherence resulted in a significant increase in PDC among patients with hypertension and diabetes. The DRAW tool can be used in a community pharmacist–delivered telephonic intervention to improve medication adherence.

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.

PHS122 - Medication Synchronization Improves Medication Adherence

To evaluate the impact of a medication synchronization program on medication adherence. This study used a retrospective cohort design with propensity score matched control group. Patients age 21+ qualified for a medication synchronization program (Save-A-Trip-Refill®) if they had 2 or more visits to Walgreens pharmacy within 30 days to fill 3 to 7 maintenance medications during a 180-day baseline period. The test group included 4,221 patients who enrolled in the program between February and September 2016 at 30 pharmacies in FL, IL and NM. The control group included patients who were qualified in the same period, in the same states but outside of test stores. Patients in the test group received live calls for enrollment into the program, synchronization planning for medication fill dates, and regularly scheduled resynchronization. The patients in the control group were propensity score matched to the test group at 1:1 ratio on baseline characteristics of age, gender, plan type, copay, comorbidities, number of medications, number of pharmacy visits, and adherence rate. Medication adherence for anti-hyperlipidemia, anti-hypertensive and anti-diabetic medications were calculated and compared between test and control groups in a 12-month follow-up period using Walgreens pharmacy claims data. Medication adherence was evaluated using both proportion of days covered (PDC) and optimal adherence (PDC ≥ 80%). Student’s t-tests and Chi-square tests were used to evaluate statistical significance of the differences. Compared to the control group, patients in the test group had significantly (p<0.001) greater PDC by 6.2%, 6.7%, and 8.1% for anti-hyperlipidemia, anti-hypertensive, and anti-diabetic medications, respectively. Percent of optimally adherent patients was also significantly (p<0.001) greater by 6.7%, 7.7%, and 9.9% respectively for the same drug classes. Medication synchronization helps patients with multiple chronic conditions improve their medication adherence which could result in better health outcomes and reduced overall healthcare cost.