Sprouse Chelsea, Grant Morgan, Remines Jamie, Nadpara Pramit, Goode Jean-Venable
Kroger Health.
Virginia Commonwealth University.
Innov Pharm. 2020 Jul 31;11(3). doi: 10.24926/iip.v11i3.3369. eCollection 2020.
Adherence, specifically to noninsulin diabetes medications, statins, and renin-angiotensin system antagonists (i.e. angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and aliskiren), is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care.
(1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patientsadherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain.
A six-month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin-angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow-up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six-month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert-scale and multiple choice-based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert-scale questionnaire. At the end of the six-month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni-variate and bi-variate statistics to determine if there was a difference in pharmacy performance scores from the pre-study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence.
A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95%) with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey.
An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs.
依从性，特别是对非胰岛素类糖尿病药物、他汀类药物和肾素 - 血管紧张素系统拮抗剂（即血管紧张素转换酶抑制剂（ACEi）、血管紧张素 II 受体阻滞剂（ARBs）和阿利吉仑）的依从性，是医疗保险和医疗补助服务中心（CMS）追踪的一项指标，用于给医疗保险 D 部分计划评定星级；药房会受到这些星级评定的影响。药房会根据该指标获得一个绩效评分。一些药房使用绩效信息管理平台（PIMP），该平台能让药房更好地理解绩效信息，从而影响患者护理。
（1）评估每月的依从性监测和教育服务是否会影响根据药房绩效评分确定的患者依从百分比；（2）确定大型社区药房连锁中患者对该服务的满意度。
在弗吉尼亚州西南部一家大型社区药房连锁的两家药房中，开展了一项为期六个月的前瞻性干预性试点研究，纳入口服糖尿病药物或肾素 - 血管紧张素系统拮抗剂（RASA）药物的覆盖天数比例（PDC）低于80%的患者。利用药房内部数据分析和PIMP数据，确定口服糖尿病药物或RASA药物的依从患者百分比，包括每位患者的基线PDC。在研究开始时，这家大型社区连锁药房的常规护理是处理依从性问题，在一个月后以及此后每三个月进行随访。在本研究中，药剂师在六个月的时间里每月提供电话依从性监测和教育。每次会话都有关于用药依从性历史、教育和数据收集的脚本。药剂师根据患者对问题的回答提供指导和咨询。在第一次会话期间，药剂师使用一份包含14项李克特量表和多项选择题的问卷收集关于依从模式和行为的信息。在完成最后一次依从性监测和教育会话后，药剂师使用一份包含8项李克特量表的问卷收集患者满意度信息。在六个月周期结束时，利用PIMP数据，根据药房绩效评分确定口服糖尿病药物或RASA药物的依从患者百分比。使用单变量和双变量统计方法对数据进行分析，以确定与研究前分析相比药房绩效评分是否存在差异。对依从模式和行为以及患者对该项目的满意度进行评估，以确定影响不依从的因素。
在两家药房中共识别出55名患者，其中10名被排除或拒绝参与，最终有45名患者纳入依从性监测和教育服务。在这45名纳入研究的患者中，有10名完成了依从模式和行为问卷。约一半患者为男性（50.95%），平均年龄71.17岁，平均服用6.55种处方药。所有患者都有医疗保险D部分保险，大多数患者年收入低于40,000美元。平均基线PDC为68.92。在药房1中，口服糖尿病药物的平均绩效评分在研究期间呈下降趋势，高血压药物的平均绩效评分呈上升趋势。在药房2中，口服糖尿病药物的平均绩效评分在研究期间呈上升趋势，高血压药物的平均绩效评分呈上升趋势。依从模式和行为问卷显示，大多数患者很少忘记服药或药物用完。此外，药物成本似乎并未影响依从性，大多数患者知道他们所服用药物的名称和适应症。只有一名患者完成了患者满意度调查。
依从性监测和教育服务在提高患者依从性和药房绩效评分方面取得了喜忧参半的结果。只有一名患者完成了满意度调查，因此无法得出关于患者对该项目满意度的结论。关于电话依从性项目，还需要进行更多研究。
