1. Community Pharmacy Adherence Services

2. Adherence to Prescription Medication Many patients have difficulty taking prescription medications as prescribed. Poor adherence causes avoidable hospitalizations, premature deaths and increases the cost of health care*. *Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97. Cutler DM, Long G, Berndt ER, et al. The Value of Antihypertensive Drugs: A Perspective on Medical Innovation. Health Aff (Millwood) 2007;26:97-110. Thinking Outside the Pillbox. A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. August 2009. Available at www.nehi.net.

3. Common Factor Among Nonadherent Patients Complexity - Multiple disease states, multiple prescribers, multiple disease, multiple drug therapies and multiple pharmacies Result - Patients are confused.

4. What Happens When Patients Have Multiple Medications*? 464 English speaking patients receiving care in one of three federally qualified health centers in Chicago, Illinois Patients were given 7 prescription bottles with varying direction and asked when they would take each medication. The prescriptions could be consolidated into 4 doses/day *Wolf et al. Helping Patients Simplify and Safely Use Complex Prescription Regimens. Arch Intern Med 2011.

5. Patient Characteristics Age 55-59 (29.3%),60-64 (33.2%), >64 (37.5%) Race White (60.8%), African American (29.7%), Other (9.5%) Education High School or less (17.7%), Some college (20.9%), College graduate (61.4%) Literacy Low (20.7%), Marginal (22.8%), Adequate (56.5%)

6. Results Dosing Regimen – Average 6 times/day (SD 1.8) Range 3-14 times/day 30.8% of patients did not take drugs E & F at the same time (despite same directions) 79% of patients did not take drugs A (twice daily) & B (every 12 hours) at the same time.

7. Results

8. Community Pharmacy Solutions Adherence Services designed to address: Access - Ensure the patient has the correct medication. Instructions - Ensure the patient knows how to take the medication.

9. Research on Community Pharmacy Solutions* Subjects – 273 clients in a state Medicaid home and community-based waiver program—a waiver program for persons eligible for nursing home care, but who prefer to receive their services in the community Intervention – Medication Adherence Packaging System & Coordinating Service. Results – Matched control group was 2.94 times more likely to be admitted to a nursing home. *Schultz RM et al. Impact of a Medication Management System on Nursing Home Admission Rate in a Community-Dwelling Nursing Home–Eligible Medicaid Population. AmJ Geriatr Pharmacother. 2011;9:69–79

10. Mass Independent Pharmacists Assn. Has many pharmacies located across the state providing a variety of solutions. Willing to survey members to determine which pharmacies are offering these services. Goal - Establish a network of pharmacies that can be used by patients who need this service.

11. Issues to be Discussed Identify the service(s) that are desired. Determine which patients would utilize the services. Who will pay for these services. Analysis of the results.

12. Two Examples Saad Dinno (Acton Pharmacy) Tim Fensky (Sullivan’s Pharmacy)