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2015 Aging in America Conference
The 2015 Aging in America Conference, held in Chicago, Illinois, from March 23 to 27, 2015, was attended by some 2,500 visitors and featured numerous presentations on wellness, mental health, sexuality, health policy, and other topics. The conference included several discussions on managing medication use in elderly patients.
A Comprehensive Approach to Providing Medicare Part D Evaluations
A Massachusetts program provided Medicare Part D reviews to 1,068 beneficiaries in 2012 that saved individuals a median of $301. Volunteer pharmacists from the Massachusetts College of Pharmacy and Health Sciences (MCPHS) conducted the reviews while helping older residents manage their prescriptions correctly at health fairs and with a year-round call-in service.
Some Part D beneficiaries saved far more than the average. Among the 647 individuals for whom the program’s pharmacists recommended a plan change, the median savings was $538. “And when you consider some of the outliers, some had $40,000 in potential cost savings,” said Colleen Massey, Director of Operations at MCPHS in Worcester, Massachusetts. They’re probably not paying that potential bill, however, “so they go without the medications and end up hospitalized,” she told conference participants.
Timothy Aungst, PharmD, an Assistant Professor at MCPHS and co-researcher on the study, says specialty drugs account for much of these costs. “For example, if someone has hepatitis C, without proper support, the disease can get out of hand and do long-term damage to your liver. Untreated multiple sclerosis can lead to hospitalization and pain,” he added.
The Appointment-Based Model of Prescription Management
Rite Aid recently became the first pharmacy chain to roll out the appointment-based model (ABM) of prescription management on a chain-wide basis. The model has grown increasingly popular since it was the subject of a trial conducted for the Alliance for Patient Medication Safety in 2011; the initial trial involved 1,585 patients.1 Jack Watters, MD, Vice President for External Medical Affairs at Pfizer Inc., discussed the ABM at the conference.
“In ABM, we take all a patient’s chronic medications, pick one, and call it the ‘anchor drug,’ ” explained David Searle, RPh, Director of Pharmacy Development at Pfizer. “That becomes the drug which determines the appointment date to come into the pharmacy. Then we take all the other medications and synchronize them. That way, a pharmacist has a chance to initiate a conversation with the patient, and learn if there are problems with their prescriptions.” The patient receives one call a month, and the pharmacist asks if it’s a good time to talk about the medications the patient is scheduled to pick up.
Pfizer expects 25% of all U.S. pharmacies to be participating in ABM by the end of 2015, Searle said. There are now 4,600 pharmacies in 31 states participating in the Pfizer-led program, serving approximately 500,000 patients. But the adoption has encountered some resistance.
“Health care adoption is slow to take effect, but pharmacy is one of the most inefficient models of health care out there, because it’s all based on getting the drug out the door,” Searle said. Pharmacists are very busy and don’t want to feel overwhelmed. “We explain that this method requires no increase in staff and no capital investment. Instead of fielding thousands of calls 10 hours a day, why not replace them with one outbound call?” The pharmacist can control the timing of these conversations (no weekends or late Friday afternoons) and improve inventory control.
Patient adherence improves, too. “We see, on average, 10.4 refills every 12 months, instead of 7.2, for every synchronized drug,” Watters said. “With seniors taking many medications comes the increased potential for the medications to interact and do harm. … The whole point of ABM is more face-to-face contact between the patient and another health care professional.”
Pharmacists’ Interventions May Improve Medication Adherence
The need for a new method of managing older patients’ prescriptions comes in an era of greater medication use overall. As of 2012, half of American adults (117 million patients) had at least one chronic health condition, and one in four American adults had two or more chronic health conditions, according to the Centers for Disease Control and Prevention. Twenty-one percent of Americans used three or more medications regularly, and 10% consumed five or more.2
Meanwhile, prescribing has changed in the doctor’s office with the push toward electronic medical records (EMRs) and electronic prescribing—and pharmacies have not caught up.
Some problems arise when a new electronic prescription from the doctor’s office fails to reach the pharmacy. “It could be a translation mistake, or they select the wrong pharmacy from the drop-down menu,” said Searle, explaining that one large software vendor managing prescriptions made by EMR systems has 55,000 drugstores in its drop-down menus. The patient has no hard-copy prescription in hand, so unless the pharmacist asks if a hospital or doctor has recently changed the patient’s prescription, the problem probably won’t be caught, Searle said.
Researchers in the U.S., Australia, and Europe are looking at ABM as a solution. One large study is under way in Florida, conducted by Humana in conjunction with two large pharmacy chains, to see if ABM reduces costs, and a Harvard study is looking at Medicare Part D data, according to Searle. Pfizer is also doing a study with Arizona Collect Care to look at the issue from an accountable care organization perspective.
Interim data suggest patient benefits. Twelve-month data showed that among patients in an ABM program, the odds of prescription adherence were 3.4 to 6.1 times higher, according to data from the Virginia Commonwealth University School of Pharmacy that was cited by Pfizer. Those patients used an average of 84 more days of medication per patient per prescription. Patients in the control group were 52% to 73% more likely to stop taking their chronic medications.3
A subjective study of pharmacist interventions conducted by a Yale University pharmacy outreach program also found data suggesting improved adherence. In an informal interview of patients who participated in Yale’s “Take It Seriously” campaign (an outreach initiative aimed at prescription management in low-income communities), 66% of participants said that as a result of speaking with a volunteer outreach pharmacist, they intended to use a system to help them take their medication properly.4
In the Yale program (conducted by the Coalition for Senior Medication Safety), three dedicated staff members, two dozen volunteer pharmacists, and students conduct medication fairs at senior centers and public housing around New Haven, Connecticut, according to Donna Fedus, Co-chair, who initiated the Coalition in 2010 and also serves as Director of Elder Programs in the Department of Psychiatry at Yale’s School of Medicine. The long-term goal of the program is to reduce prescription medicine misuse among low-income minority adults by 3%.
- Holdford DA, Inocencio T. Patient centric model: pilot data analysis report. Alliance for Patient Medication Safety. April 2011. Available at: https://naspa.us/documents/grants/abm/NASPA%20Report%204-08-2011%20Final%20Reports.pdf. Accessed April 23, 2015.
- Centers for Disease Control and Prevention. Chronic diseases and health promotion. May 9, 2014. Available at: www.cdc.gov/chronicdisease/overview/index.htm. Accessed April 10, 2015.
- Holdford D, Inocencio T. Appointment-based model (ABM) data analysis report. Virginia Commonwealth University School of Pharmacy. January 2013. Available at: http://www.ncpanet.org/pdf/adherence/thriftywhitemedadherencestudy.pdf. Accessed April 10, 2015.
- Coalition for Senior Medication Safety, Take It Seriously campaign. INFO Brief: summary of results. Available at: http://www.ct.gov/dmhas/lib/dmhas/prevention/Info_Brief_New_Haven_Elderly_Final.pdf. Accessed April 10, 2015.