Browsing by Subject "Medication adherence"

Now showing 1 - 4 of 4
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    Chronic medication adherence: its association with health care costs.
    (2011-07) Zhou, Siting
    Effective treatment for high-prevalence chronic diseases requires medication adherence. Improved medication adherence increases medication utilization, which leads to higher pharmacy costs. However, higher adherence may reduce medical services use that result in decrease in overall health care costs despite the increase in pharmacy costs. The objective of this study was to examine the impact of medical adherence on health care costs. The secondary objective of this study was to assess the independent effect of consumer directed health plans (CDHPs) on health care costs. The study samples were three independent cohorts of individuals with the separate conditions of diabetes, hypertension and hypercholesterolemia, identified from a pharmacy benefits management company between January 1, 2007 and December 31, 2009. Medication adherence was measured using Proportion of Days Covered (PDC) endorsed by Pharmacy Quality Assurance (PQA). Health care costs were measured at two levels: all-cause and condition-specific. At each level, pharmacy, medical and total health care costs were calculated. The generalized linear model with a gamma log link was used to fit six statistical models for each disease cohort. Control variables included patients’ demographics, socioeconomic information, health status, health services utilization. There were 22,012 individuals in the diabetes cohort, 64,600 in the hypertension cohort and 59,003 in the hypercholesterolemia cohort. At all-cause level, increased PDC was significant associated with decreased medical costs across the three cohorts (p<0.05). At condition-specific level, increased PDC was significant associated with decreased medical costs in the hypertension and hypercholesterolemia cohorts (p<0.001), but with increased medical cost in the diabetes cohort (p<0.001). Due to the significant increase in pharmacy costs associated with higher PDC (p<0.001), total health care costs were increased (p<0.001) both at all-cause and condition-specific levels in each cohorts. Enrollment in CDHPs was generally associated with decreased medical, pharmacy, and total health care costs at all-cause and condition-specific levels across the three cohorts. As adherence increases, the savings in medical costs are not able to offset the increase in pharmacy costs. Therefore, measures that aim to reduce pharmacy cost while preserving or improving adherence are needed.
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    Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice
    (University of Minnesota, College of Pharmacy, 2011) Pringle, Janice; Melczak, Michael; Aldridge, Arnie; Snyder, Margie; Smith, Randall
    Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients who received MTM without use of the TA scale (MTM only). Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics. Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting. Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2. Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome Measures Proportion of Days Covered (PDC) and PDC80. Results: Using the therapeutic alliance scales in the context of community pharmacist-provided MTM was associated with a 3.1 percentage point increase in patients’ overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales. Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice.
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    Medication therapy management (MTM): a tool for optimizing clinical and economic outcomes in the management of chronic diseases
    (2013-04) Soliman, Ahmed Mohamed Ahmed
    Medication Therapy Management (MTM) is an innovative pharmacist-led and delivered pharmacy service that aims to resolve drug therapy problems, improve patient education and increase medication adherence. This dissertation sought to evaluate the impact of receiving MTM services on clinical, economic and behavioral outcomes. The first manuscript showed that diabetes patients exposed to MTM were more likely to meet the glycosylated hemoglobin clinically defined goal compared to a control group of diabetes patients. The second manuscript showed that diabetes patients who took insulin or had diabetes complications were more likely to receive a higher number of MTM visits. The third manuscript showed that patients who took four or more chronic medications had a significant cost reduction seven months after the first MTM encounter compared to a matched cohort of patients who were never exposed to MTM services. Similar results were observed in the fourth manuscript which examined the economic outcomes in diabetes patients who were taking insulin. The last manuscript showed that MTM services resulted in improvement in medication adherence (measured by proportion of days covered (PDC)) across five different classes of chronic disease medications. Taken together, this body of work shows that MTM services is a potential tool that could be used by policy makers and health plan administrators to improve patient outcomes across multiple dimensions of care.
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    Remember Your MEDS: Medication Education Delivers Success
    (University of Minnesota, College of Pharmacy, 2012) Rife, Kelsey M.; Ginty, Sarah E.; Hohner, Elizabeth M.; Stamper, Heather R.; Sobota, Kristen F.; Bright, David R.
    Background: Medication adherence is one of the largest barriers to better patient outcomes today. As pharmacists and student pharmacists expand their roles with community outreach projects, they have the potential to make a huge impact on improving adherence. Objective: To improve medication adherence through patient counseling and constructive resources, and to determine patient preferences of adherence tools. Methods: Student pharmacists partnered with a 340B pharmacy to promote the importance of medication adherence. Patients were counseled in an initial 10 minute session, and then given the opportunity to receive one or more of the following adherence tools: a pill box, timer, reminder refrigerator magnets, calendar stickers, refill reminder phone calls and/or text message reminders. A pre-survey was conducted to establish the patients’ baseline medication adherence using the validated ©Morisky Medication Adherence Scale (©MMAS-8). After three months, students conducted the post-survey via the ©MMAS-8 by calling the patients and asking them questions about the helpfulness of the adherence tools as well as the effectiveness of the initial counseling visit. Results: Sixty five patients with hypertension enrolled in the study, and 51 patients completed both the pre- and post-surveys. Patients improved from a 6.02 (SD +/- 1.62) average pre-score to a 6.83 (SD +/-1.25) average post score (p < 0.001). Pill boxes, text message reminders, and calendar stickers were respectively ranked as the top 3 most helpful tools studied. The refrigerator magnets were also considered helpful by most patients who used them. The timers were ranked the least helpful, mostly due to difficulty of use. Conclusion: Student pharmacists can have a positive impact on medication adherence through simple counseling and offering effective adherence tools.