Transcript Day 2 Community Phar..

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)