To identify the impact that personalized pharmacist interventions have on patient adherence by comparing the proportion of days covered (PDC) between patients who received two interventions to those who received more than two interventions.
Background: Medication adherence rates in patients with chronic diseases range between 40-70% and cause one of the highest preventable costs in the health care system.1 Pharmacists have the knowledge and skills to improve medication adherence.2 Value-based care is one way that pharmacies are incentivized to improve medication adherence through reimbursement from Medicare Part D plans based on pharmacy Star Ratings. PDC is one measurement of adherence and is used to determine Star Ratings adherence metrics. Smith’s Pharmacy can obtain additional reimbursement from insurance companies if their patients’ PDCs meet the targets specified in their contracts with Medicare Part D plans. This project looked at the Adherence Monitoring Program at Smith’s Pharmacy to determine if individualized pharmacist interventions increase adherence determined by PDC.
Methods: This study performed a retrospective cohort study to examine the effectiveness of Smith’s Pharmacy Adherence Monitoring Program from January 2017 – December 2018. Those included in this study are patients who had PDCs below 80%, received prescriptions at one of 139 Smith’s Pharmacy locations, had Medicare Part D coverage, and were targeted for and accepted interventions by a community pharmacist. Patients received a personalized intervention through a phone call or in-pharmacy visit to discuss adherence. The study involved reviewing patient data and running several statistical analyses to determine effectiveness, including the Chi-Square test and the Paired t-test through the STATA analysis software program. Interventions were evaluated to determine how the number of adherence encounters between a patient and a pharmacist impacts the patient PDC, comparing patients who received two interventions to those who received three or more interventions. This study aimed to determine the clinical significance of the Adherence Monitoring Program on the patient’s PDC, rather than statistical significance alone.
Results: The mean change in PDCs for each group and medication classes was analyzed using a Paired t-test. The mean change in PDC for patients on a renin-angiotensin system antagonist (RASA) who received two interventions and patients who received three or more was -0.58 PDC% points and 2.13 PDC% points, respectively, with a p-value of 0.0582. The mean change in PDC for patients on a statin who received two interventions and patients who received three or more was -0.42 PDC% points and 3.18 PDC% points, respectively, with a p-value of 0.0129. The mean change in PDC for patients on an oral diabetes medication who received two interventions and patients who received three or more was -0.18 PDC% points and .40 PDC% points, respectively, with a p-value of 0.7888. Those with a PDC above 80% who take RASAs are 233 out of 449 patients, 101 with two interventions and 132 with three or more interventions. The Chi-Square analysis resulted in a p-value of 0.017. Those with a PDC above 80% who take statins are 220 out of 452 patients, 93 with two interventions and 127 with three or more interventions. The Chi-Square analysis resulted in a p-value of 0.017. Those with a PDC above 80% for oral diabetes medication are 101 out of 216 patients, 39 with two interventions and 62 with three or more interventions. The Chi-Square analysis resulted in a p-value of 0.136.
Conclusions: The results of this project show that as patients receive more personalized pharmacist adherence interventions, their adherence, measured by PDC, increases. The study showed clinical significance for the three or more intervention group in each drug class. Smith’s Pharmacy can take these results and find ways to further increase medication adherence within this Adherence Monitoring Program. As pharmacists spend time with their patients through these personalized interventions, they can improve adherence to create better health outcomes, lower healthcare costs, and lead to increased reimbursement from Medicare Part D plans.Published in