Helping Heart Patients Streamline Drug Routines

Working with patients and prescribers to consolidate prescription routines and centralize pharmacy services may boost adherence to cardiovascular medications.

In addition to the emotional stress that comes with a diagnosis of cardiovascular disease, heart patients must also face the harsh reality of living with a long-term illness. For many, that means committing to a lifetime of juggling appointments with a rotating cast of physicians and specialists, continuously tweaking their diet and exercise routines, and following a complex regimen of medications to keep the condition in check.

Research has associated these challenges with poor medication adherence. A recent study showed that a patient’s drug routine—including where and when prescriptions are filled—is a major part of the equation. According to the analysis of 2.6 million prescriptions tracked by CVS Caremark, heart patients are less likely to fill prescriptions when they come from different prescribers and require multiple treks to and from the pharmacy.

In a report on the study published in the May 2011 issue of the Archives of Internal Medicine, lead author Niteesh Choudhry, MD, PhD, of Brigham and Women’s Hospital and Harvard Medical School, wrote that patients with the most complex prescription patterns had 8% poorer adherence rates for statins, angiotensin-converting enzyme inhibitors, and renin angiotensin receptor blockers than those with the simplest patterns.

Even typical heart patients face levels of complexity that are “nothing short of dramatic,” said Dr. Choudhry. For the study, “The Implications of Therapeutic Complexity on Adherence to Cardiovascular Medications,” he and colleagues assessed prescription patterns by using pharmacy claims data to measure the number of medications, prescribers, pharmacies, pharmacy visits, and visits per fill for each patient.

During the 90-day window the researchers analyzed, patients filled an average of 11 prescriptions for medications from 6 different drug classes, had prescriptions from 2 prescribers, and visited the pharmacy 5 times. In the same period, those with the most complicated patterns filled 23 or more medications from 11 or more drug classes, had prescriptions written by 4 or more prescribers, and visited the pharmacy 11 or more times.

A home for every prescription?

Nonadherence caused by unwieldy routines could lead to costly complications, poor clinical outcomes, and a lower quality of life for patients. To address these issues, pharmacy benefit manager CVS Caremark, which funded the study, is weighing the merits of a “pharmacy home” that centralizes pharmacy services into a single point of contact.

Proposed by the study’s authors, the pharmacy home model applies the basic principles of the patient-centered medical home to pharmacy care. Although the recent therapeutic complexity study does not prove that filling prescriptions at a single pharmacy will increase adherence, its authors write that “consolidating prescriptions in a single pharmacy home may help improve health care quality.”

Until the theory is tested, however, the burden falls on patients and members of their health care team to work within the current system to optimize medication management. In an interview with Reuters, Dr. Choudhry explained that although physicians should discuss the issue with patients, pharmacists especially are equipped to deal with issues related to refill consolidation and prescription scheduling.

“This is a tough problem for doctors to solve themselves,” he said.

For other articles in this issue, see:

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