Patient Prescription Coordinators Improve Access to Low Cost Medications

A study found that patient prescription coordinators can help navigate manufacturer prescription assistance programs (PAPs), resulting in the reduction of hospital admissions and emergency room visits.

PAPs were created to help provide eligible patients with medications at little to no cost, but with more than 200 PAPs available with differing eligibility requirements and assistance guidelines, it can be confusing, according to research published in the Journal of Managed Care and Specialty Pharmacy.

In order to help navigate the system, a formalized community-based patient prescription coordinator can help patients choose PAPs that are right for them by reviewing their financial information and medication requirements.

Researchers wanted to see how useful these prescription coordinators were by evaluating changes in hospitalization and emergency department visits.

Patients enrolled in the Spokane Prescription Assistance Network (SPAN) program between March 1, 2009 and August 31, 2012 who received a PAP referral were used in the study (n=461). Social service agencies or a medical provider sent referrals to the SPAN patient prescription coordinator for patients having difficulty paying for prescription medications.

Patients were initially contacted while undergoing treatment in a clinic or hospital or through a direct visit to a coordinator’s office. Participants were then contacted 6 months after the initial appointment, followed by annual meetings to review current health status and medications.

Electronic health records gave researchers information on hospitalizations and emergency department visits 12 months before and after program enrollment.

During the initial interview screening, participants who rejected the informed consent process were rejected from participating in the study (n=151), leaving 310 adults who were 18-years-old and older who participated.

Of the participants, nearly two-thirds were female with a median age of 48-years-old. Patients had health quality life scores significantly below that of similarly aged adults. Normalized scales from the SF-8 Health Survey were used with a score of 50 that indicated average health.

At the start of the study, SPAN participants had SF-8 scores below 40 over 2 standard deviations lower than norms for the general United States population related to physical (median = 37.5, IQR = 28.2-48.3) and mental (median = 38.3, IQR = 28.9-47.1) function.

At program entry, a median of 3 prescription medications were prescribed per person (IQR = 2-6). The most common prescriptions were for anti-hyperglycemic and diabetic, cardiovascular, psychotropic, or pulmonary medications. Upon enrollment, more than 60% of study samples (n=187) had at least 1 prescribed psychotropic medication.

The results of the study reported that there was a decline in emergency and hospital admissions from 0.38 per person in the year before enrollment to 0.20 in the year after program entry.

The repeated-measures mixed-effects model indicated that SPAN participation was association with a 51% decline in ER and hospital utilization (IRR = 0.49; 95% confidence interval [CI] = 0.31-0.77; P = 0.002) for acute care encounters.

Those most likely to use acute care services during the study were the younger aged groups, with a marked increase in the youngest adults aged 18 to 34-years-old (IRR = 4.82; 95% CI = 2.77-8.37; P < 0.001).

Factor interactions revealed that participants who were prescribed psychotropic medications had an increased higher acute care utilization rate (IRR = 2.07; 95% CI = 1.32-3.24; P = 0.001).

Patients who took pulmonary medications were associated with a lower acute care utilization rate (IRR = 0.58; 95% CI = 0.37-0.92; P = 0.019).

The data collected from the study reported that facilitated enrollment in PAPs is associated with overall reduced acute care utilization rates. Decreased rates were found to be most prominent in patients taking pulmonary medications.

However, the study found that those taking psychotropic medicates were more likely to be admitted to the emergency department or hospital.

Some limitations within the study included: a lack of a randomly assigned control group; lack of suitable comparison groups; unavailable information on patients who did not consent to the study; the sample was taken from a single community health system; outcomes data could be missing for some of the participants; and some emergency department or inpatient hospital visits may have occurred outside the region were not included.

The study concluded that a patient prescription coordinator who helps aid patients in gaining access to low cost medications could prove valuable in the reduction of visits to emergency room and inpatient hospital admissions.