Pharmacists Improve Chronic Medication Adherence Across Communities

Community pharmacists dramatically boost medication adherence among patients with chronic conditions.

A nationally scalable intervention implemented by community pharmacists dramatically boosted medication adherence among patients with chronic conditions who consistently struggle with sticking to their prescription regimens, according to research published this week in Health Affairs.

“Medication therapy management is the best-known systematic patient intervention provided by community pharmacies. However, it focuses mainly on the most clinically complex patients at highest risk for nonadherence and has generally been ineffective in improving adherence across an entire patient population,” Janice L. Pringle, PhD, director of the Program Evaluation and Research Unit at the University of Pittsburgh School of Pharmacy, and her coauthors wrote in the study. “Instead, effective interventions that target patients at a broader array of nonadherence risk levels are thought to be essential to improving population adherence rates.”

Noting that community pharmacies offer an ideal setting for such interventions, given that approximately 71% of all patients receive their medications from their community pharmacists, Dr. Pringle and her colleagues evaluated the effectiveness of a model that uses a broad risk stratification tool and a pharmacist-provided intervention, as well as its impact on patients’ adherence to 5 common chronic medication classes and overall health care costs.

To implement their large-scale demonstration study, entitled the Pennsylvania Project, the researchers trained 283 pharmacists at 107 Rite Aid pharmacies to quickly survey patients about their prescribed medications and engage in brief discussions with those whose screening scores indicated they had poor adherence risk. Collectively, the intervention pharmacists screened 29,042 patients throughout the study, while a control group of 295 pharmacists at 111 Rite Aid pharmacies that did not implement the intervention screened 30,454 patients.

After comparing outcomes in both groups over a 330-day period, the study authors found medication adherence rates improved among those in the intervention group across the 5 examined drug classes, ranging from 3.1% for beta-blockers to 4.8% for oral diabetes drugs, while the rates slightly dropped in the control group for all medication classes except statins.

“If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically, and the risk for severe health problems, such as heart attack or stroke, would be reduced. Patients would live longer and probably enjoy a higher quality of life,” Dr. Pringle stated in a press release from Pharmacy Quality Alliance (PQA), which funded the Pennsylvania Project. “This untapped resource could be harnessed and used to improve public health and reduce overall health care costs.”

In fact, the study showed annual health care spending per patient fell by $241 for those taking statins and $341 for those taking oral diabetes medications, which the authors said translates to a total estimated savings of $1.4 million over a 1-year period for a payer with 10,000 members receiving statins, oral diabetes drugs, or both.

“The cost savings demonstrated by the Pennsylvania Project should draw the attention of many payers to the value of leveraging pharmacists in the community where their members live to improve health and wellness and reduce overall health care costs,” said study co-author Jesse McCullough, PharmD, director of field clinical services at Rite Aid, in the press release. “This is another area where the value of the pharmacist to the health care system is demonstrated.”