Browsing by Subject "medication adherence"
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Item The Effect of a Novel Proactive First Day Prescription Counseling Program on Adherence to Select Cardiovascular Medications(University of Minnesota, College of Pharmacy, 2011) McConaha, Jamie L.; Lynch, KevinObjective: To determine the impact of a proactive first day prescription counseling program on medication adherence to new cardiovascular maintenance medications Design: Cross-sectional study Setting: Regional chain community pharmacy in Pittsburgh, Pennsylvania; August 2009 through November 2010 Patients: Data was collected from all patients aged 18-89 presenting with a new or transferred prescription or change in dosage within the study dates at four study locations Interventions: Patients presenting with a new or transferred prescription or change in dosage were identified to receive pharmacist or student pharmacist counseling. Data from the counseling session was tracked weekly to determine if the program increased adherence to statins, ACEIs and/or ARBs. Main Outcome Measured: Adherence to statins, ACEIs and/or ARBs was determined by differences in proportion of days covered (PDC) at six months and medication persistence to therapy. Results: Analysis was conducted using IDNA sm software. Results of the 6,916 prescriptions included in the study revealed that persistence rates for statins was 32.5% (intervention) and 34.2% (control) (p<0.001); ACEI/ARBs persistence was 37.3% (intervention) and 43.2% (control) (p<0.001). PDC was nonsignificant with respect to statins; 43.2% (intervention) and 45.1% (control); and 50.2% (intervention) and 57.1% (control) (p<0.001) for the ACEI/ARBs. Conclusion: Results from this study showed no improvement in adherence of statins or ACEIs/ARBs with the D1TC program versus control pharmacies, although several important limitations were identified. It is clear that a variety of methods and programs are needed to consistently improve adherence to maintenance medications.Item The impact of pharmacy benefit design changes on medication adherence and generic drug utilization among commercially insured continuously enrolled patients with chronic diseases(2015-08) Su, WeipingWhile it is crucial for health plans to be protected against rising prescription drug costs, increasing cost sharing too much may mean that beneficiaries can not afford medication and non-compliance will become an issue. The objective of the study was to investigate the impact of pharmacy benefit design (PBD) changes on adherence to chronic medications and generic utilization. The study samples were three cohorts of commercially insured continuously enrolled patients with pharmacy claims of diabetes, hypertension, and hyperlipidemia between Oct. 1, 2010 and Jun. 30, 2013. Pre and post quasi-experimental design with control group was applied. To understand the impact comprehensively, PBD changes were examined in two steps: Step 1: Any changes in PBD; Step 2: Changes in cost sharing strategies only. Medication adherence was measured in proportion of days covered (PDC) by at least one medication of the target disease. PDC was also dichotomized as PDC>=80% and PDC<80%. Generic utilization was measured as the generic dispensing rate (GDR) for all medications took during the study period. Two statistical models were fit: General Linear Regression model for the continuously measured variables of PDC and GDR; and Logistic Regression for dichotomized PDC. Control variables were classified into three categories based on Andersen's behavioral model: predisposing characteristics, enabling resources, and need factors, including beneficiaries' demographic and socioeconomic information, medication conditions, and a proxy health risk estimate using Prospective Risk Score. The study sample was made up of 445,983 patients, of whom 45,850 were identified with benefit changes and 400,133 were not. In the experimental group, 8,049 beneficiaries had claims for diabetes, 36,712 beneficiaries had claims for hypertension, and 20,704 beneficiaries had claims for hyperlipidemia. The final control groups were randomly selected and were three times the number of those in the experimental group for each disease respectively. Mean pre-PDC is significantly higher than post-PDC, and mean pre-GDR is significantly lower than post-GDR for both groups. All models indicated no significant association between adherence and PBD changes. There were, however, significant associations between GDR and PBD changes in two cohorts. Beneficiaries with PBD changes had 0.007(p=0.0002) higher post-GDR in the diabetes cohort; beneficiaries with PBD changes had 0.004 (p<0.001) higher post-GDR in the hypertension cohort. Neither cost-sharing strategy had a significant impact on PDC within studied pharmacy benefit designs. Generic dispensing rate was also not significant associated with most of the cost sharing strategies except the copayment decrease of generics. For beneficiaries with a decrease in the amount of copayment for generic products, the mean post-GDR was 0.017 (p=0.0003) lower than beneficiaries without copayment changes in the diabetes cohort, although not significant in the hypertension and hyperlipidemia cohorts. Within the studied pharmacy benefit designs, design changes did not seem to affect medication adherence, but did positively affect generic drug utilization.Item Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program(University of Minnesota, College of Pharmacy, 2012-12) McKenzie, Mallory C.; Lenz, Thomas L.; Gillespie, Nicole D.; Skradski, Jessica J.Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization’s outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM), lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC) and the Medication Possession Ratio (MPR). Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01). The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence) for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01). The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence) pre enrollment versus post enrollment (+10%, P=0.086). The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for at least one year and was shown to be better when compared to a matched cohort of similar age, condition and region.Item Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)(University of Minnesota, College of Pharmacy, 2014) Tan, Xi; Patel, Isha; Chang, JongwhaItem Value of Online Medication Therapy Management Resources: Community Pharmacist Perspectives(University of Minnesota, College of Pharmacy, 2014) Doucette, William R.; Nguyen, Elaine; Zhang, Yiran; Pendergast, Jane F.; Chrischilles, Elizabeth A.; Farris, Karen B.; Frank, JessicaObjectives: To describe pharmacists’ attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services. Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists’ opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics. Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services. Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients.