Two Pharmacy Interventions to Improve Refill Persistence for Chronic Disease Medications
Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA. Medical care
(Impact Factor: 3.23).
02/2009; 47(1):32-40. DOI: 10.1097/MLR.0b013e3181808c17
Despite the proven effectiveness of many medications for chronic diseases, many patients do not refill their prescriptions in the required timeframe.
Compare the effectiveness of 3 pharmacist strategies to decrease time to refill of prescriptions for common chronic diseases. RESEARCH DESIGN/SUBJECTS: A randomized, controlled clinical trial with patients as the unit of randomization. Nine pharmacies within a medium-sized grocery store chain in South Carolina were included, representing urban, suburban, and rural areas and patients from a variety of socioeconomic backgrounds. Patients (n = 3048) overdue for refills for selected medications were randomized into 1 of 3 treatment arms: (1) pharmacist contact with the patient via telephone, (2) pharmacist contact with the patient's prescribing physician via facsimile, and (3) usual care.
The primary outcome was the number of days from their recommended refill date until the patient filled a prescription for any medication relevant to his/her chronic disease. Prescription refill data were obtained routinely from the pharmacy district office's centralized database. Patient disposition codes were obtained by pharmacy employees. An intent-to-treat approach was used for all analyses.
There were no significant differences by treatment arm in the study outcomes.
Neither of the interventions is more effective than usual care at improving persistence of prescription refills for chronic diseases in overdue patients.
Available from: Andrew W Roberts
- "Two articles (Blalock et al., 2010; Doucette et al., 2009) discussed difficulties that study pharmacists experienced when attempting to communicate with physicians. Finally, in a study involving refill reminders, 45% of the physicians contacted declined to participate (Nietert et al., 2009). Only one study described the processes through which pharmacy staff communicated with one another to coordinate service delivery (Berringer et al., 1999). "
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ABSTRACT: Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings.
Available from: Melissa Somma Mcgivney
- "In 38% (11/29) of the studies a change in medication adherence was not seen.17-20,26,27,29,31,35,43,47 In 24% (7/29) of the studies, an inadequate sample size to detect differences in adherence was identified as a limitation.19,24,25,28,29,35,43 The use of self-reported medication adherence was also problematic as baseline medication adherence was frequently higher than expected (patients often overestimate their adherence).22,26,28,29,35,43 "
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ABSTRACT: ABSTRACT Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States.Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals.Results: Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence. Education: National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students’ awareness of adherence barriers and communication skills needed to engage patients in behavioral change. Policy: Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence. Conclusions: Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes.
Available from: factsandcomparisons.com
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ABSTRACT: agents administered during hospi- talization at a tertiary care acade- mic medical center. The retrospec- tive analysis was conducted over 1 year. A total of 416 allergies were reported among 300 patients; more than 1 allergy was reported by more than one-fourth of study patients (82/300 (27.3%)). Only 36.3% (151/416) of allergies reported were accompanied by a reaction description (95% confi- dence interval (CI), 31.7% to
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