Monthly Pharmacy Visits Improve Adherence

A program in which patients taking medication for multiple chronic conditions picked up all their medications on the same day of the month and regularly met with a pharmacist led to increased adherence.

Patients whose chronic medications were all synchronized to be refilled on the same day each month and who regularly met with a pharmacist were more likely to take the drugs as prescribed, a new study finds.

The study, published in the November/December 2013 issue of the Journal of the American Pharmacists Association, tested the effectiveness of an appointment-based medication synchronization program on medication adherence and persistence in patients taking multiple chronic medications. The program combined 2 of the most successful strategies used to improve medication adherence: constant monitoring tailored to a patient’s specific needs and standardized refill dates for complex regimens.

The quasi-experimental study was conducted in Thrifty White Pharmacy locations in rural areas of Midwestern states. Patients receiving at least 2 refills for angiotensin-converting enzyme inhibitors, beta blockers, dihydropyridine calcium channel blockers, thiazide diuretics, metformin, or statins were contacted by the pharmacy about the program. Interested patients were scheduled for a synchronization appointment, and their medication use was monitored from June 30, 2011, through October 31, 2012.

During the first synchronization appointment, pharmacists reviewed the patient’s medications, established the monthly medication refill date, scheduled a monthly call to review current medications and identify any necessary changes to the regimen, calculated a cost estimate for monthly prescriptions, and answered any questions the patient had about the program or their medications. The appointments were tailored to each patient’s needs, and pharmacists worked to identify and address patients’ specific barriers to adherence. Patients were reminded to pick up their medications 3 days before their refill date and could opt to have their prescriptions delivered or mailed. Specialized software tracked patient progress, scheduled reviews of prescription records, and sent automated messages to patients before pharmacy visits.

Patients who participated in the program had significantly higher adherence rates than those who chose not to enroll in the program. Depending on the drug class, program participants were covered by their medications for 80% to 87% of the days in the month on average, while control patients had their medications on hand only 58% to 63% of the days. Over 1 year, 66.1% to 79.5% of program patients were considered adherent, compared with 37.0% to 40.8% of those who did not participate in the program. Patients in the program had 3.4 to 6.1 times the odds of being adherent compared with control patients, and control patients were 52% to 73% more likely to stop taking their medications over the year. Approximately 67% to 74% of control patients became non-persistent, compared with just 34% to 48% of program patients.

The results indicate the effectiveness of the program in improving adherence. However, more research is needed to investigate its long-term effects. Although medication synchronization may have played a large role in improving adherence rates, the authors of the study note that patient interaction with pharmacists was also an important factor.

“Although synchronization can help remind patients, provide updates on their progress, simplify the process, and make refilling a prescription more convenient, the monthly appointment allows pharmacists to educate, engage, and solve problems,” they write. “Overemphasizing synchronization can miss a key ingredient of the program’s value.”