Krumme Alexis A, Isaman Danielle L, Stolpe Samuel F, Dougherty Samantha, Choudhry Niteesh K
Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120. E-mail:
Am J Manag Care. 2016 Mar;22(3):179-86.
The burden of visiting pharmacies to fill medications is a central contributor to nonadherence to maintenance medications. Recently, pharmacies have begun offering services that align prescription fill dates to allow patients to pick up all medications on a single visit. We evaluated the prevalence and structure of synchronization programs and evidence of their impact on adherence and clinical outcomes.
Mixed-methods approach consisting of semi-structured interviews, data from surveillance activities, and a systematic literature review.
We conducted interviews with opinion leaders from nonprofit advocacy organizations and exemplary synchronization programs. Program prevalence was determined using data from regular surveillance efforts. A literature review included Medline, EMBASE, Google Scholar, and general Internet searches.
Synchronization programs exist in approximately 10% of independent, 6% of stand-alone chain, and 11% of retail store pharmacies. The majority of programs include a monthly pharmacist appointment and reminder communication. Programs reported the importance of pharmacist buy-in, technology to track and recruit patients, links to other healthcare services, and flexible solutions for managing costs and communication preferences. Although existing peer-reviewed literature suggests that synchronization improves adherence, more evidence is needed to evaluate its impact on patient-centered outcomes.
As medication synchronization programs shift directions and compete for patients and payer resources, it will be more important than ever to rigorously evaluate their ability to improve clinical outcomes while also providing the growing number of patients managing multiple chronic conditions with the highest level of patient engagement and consumer choice.
前往药房取药的负担是导致维持性药物治疗依从性差的一个主要因素。最近,药房开始提供调整处方取药日期的服务,以便患者能在一次就诊时取走所有药物。我们评估了同步配药计划的普及率、结构及其对依从性和临床结局影响的证据。
采用混合方法,包括半结构化访谈、监测活动数据和系统文献综述。
我们采访了非营利性倡导组织的意见领袖和典型的同步配药计划。利用常规监测工作的数据确定计划普及率。文献综述包括检索Medline、EMBASE、谷歌学术以及一般的互联网搜索。
约10%的独立药房、6%的独立连锁药房和11%的零售药店存在同步配药计划。大多数计划包括每月与药剂师预约及提醒沟通。这些计划强调了药剂师认可、跟踪和招募患者的技术、与其他医疗服务的联系以及管理成本和沟通偏好的灵活解决方案的重要性。尽管现有同行评审文献表明同步配药可提高依从性,但仍需要更多证据来评估其对以患者为中心的结局的影响。
随着药物同步配药计划转变方向并争夺患者和支付方资源,比以往任何时候都更重要的是要严格评估它们改善临床结局的能力,同时还要为越来越多管理多种慢性病的患者提供最高水平的患者参与度和消费者选择。