Day 2 Community Phar..
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Community Pharmacy
Adherence Services
Adherence to Prescription
Medication
Many patients have difficulty taking
prescription medications as prescribed.
Poor adherence causes avoidable
hospitalizations, premature deaths and
increases the cost of health care*.
*Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97.
Cutler DM, Long G, Berndt ER, et al. The Value of Antihypertensive Drugs: A Perspective on Medical
Innovation. Health Aff (Millwood) 2007;26:97-110.
Thinking Outside the Pillbox. A System-wide Approach to Improving Patient Medication Adherence
for Chronic Disease. August 2009. Available at www.nehi.net.
Common Factor Among
Nonadherent Patients
Complexity - Multiple disease states,
multiple prescribers, multiple disease,
multiple drug therapies and multiple
pharmacies
Result - Patients are confused.
What Happens When Patients Have
Multiple Medications*?
464 English speaking patients receiving care in
one of three federally qualified health centers in
Chicago, Illinois
Patients were given 7 prescription bottles with
varying direction and asked when they would
take each medication. The prescriptions could
be consolidated into 4 doses/day
*Wolf et al. Helping Patients Simplify and Safely Use Complex Prescription
Regimens. Arch Intern Med 2011.
Patient Characteristics
Age 55-59 (29.3%),60-64 (33.2%), >64 (37.5%)
Race White (60.8%), African American (29.7%),
Other (9.5%)
Education High School or less (17.7%), Some
college (20.9%), College graduate (61.4%)
Literacy Low (20.7%), Marginal (22.8%),
Adequate (56.5%)
Results
Dosing Regimen – Average 6 times/day
(SD 1.8) Range 3-14 times/day
30.8% of patients did not take drugs E & F
at the same time (despite same
directions)
79% of patients did not take drugs A
(twice daily) & B (every 12 hours) at the
same time.
Results
Community Pharmacy Solutions
Adherence Services designed to address:
Access - Ensure the patient has the
correct medication.
Instructions - Ensure the patient knows
how to take the medication.
Research on Community Pharmacy
Solutions*
Subjects – 273 clients in a state Medicaid home and
community-based waiver program—a waiver program
for persons eligible for nursing home care, but who
prefer to receive their services in the community
Intervention – Medication Adherence Packaging System
& Coordinating Service.
Results – Matched control group was 2.94 times more
likely to be admitted to a nursing home.
*Schultz RM et al. Impact of a Medication Management System on Nursing
Home Admission Rate in a Community-Dwelling Nursing
Home–Eligible Medicaid Population. AmJ Geriatr Pharmacother. 2011;9:69–79
Mass Independent Pharmacists Assn.
Has many pharmacies located across the
state providing a variety of solutions.
Willing to survey members to determine
which pharmacies are offering these
services.
Goal - Establish a network of pharmacies
that can be used by patients who need
this service.
Issues to be Discussed
Identify the service(s) that are desired.
Determine which patients would utilize
the services.
Who will pay for these services.
Analysis of the results.
Two Examples
Saad Dinno (Acton Pharmacy)
Tim Fensky (Sullivan’s Pharmacy)