Simplifying refill process boosts medication adherence for CVD patients

Pharmacy programs allowing Medicare beneficiaries with cardiovascular disease (CVD) to pick up all of their medications at once were associated with a boost in adherence, particularly for those with low baseline adherence, according to a study published in the January edition of Health Affairs.

Patients with CVD have been found to average 20 trips to the pharmacy each year, with 10 percent requiring 44 or more trips. Those complex prescription regimens can lead to inconsistent filling habits and nonadherence, according to lead author Alexis A. Krumme, PhD, and colleagues.

To study the effects of pharmacy programs that make the refill process simpler and more standardized for patients, the researchers propensity-score matched 6,519 Medicare beneficiaries enrolled in a synchronization program to 16,286 control patients not enrolled in a synchronization program. All patients were taking medication for two or more chronic conditions, at least one of which was hypertension, hyperlipidemia or diabetes.

The average monthly proportion of days covered by medication was 87 percent for those in a synchronization program compared to 84 percent for control patients. Compared to patients with high baseline adherence, those with low baseline adherence enrolled in a synchronization program demonstrated a threefold improvement in proportion of days covered.

“These results, which are aligned with findings from two other studies, support the hypothesis that patients with erratic filling behaviors benefit more from the support provided by the program than do those with more consistent filling behaviors,” Krumme and coauthors wrote. “Future programs may consider targeting outreach enrollment specifically to patients with lower adherence, who may benefit the most.”

Average monthly rates of hospitalization and emergency department visits were 9 percent and 3 percent lower, respectively, for synchronized patients versus controls. In addition, there was a nonsignificant reduction in the rates of major adverse cardiovascular events—9.5 per 100 person-years versus 10 per 100 person-years.

“These results are consistent with those of several studies of adherence-improving interventions that have found that even modest adherence differences of 4 to 6 percentage points translate into improved resource use and clinical outcomes over time,” Krumme et al. wrote. “Medication synchronization may lead to more consistent medication use, which allows patients to fully realize the benefits of prescribed therapy and averts health care encounters resulting from medication-related adverse events.”

The authors noted early enrollees in the synchronization programs may have been more health conscious than general consumers and therefore more likely to adhere to medication. They suggested future studies evaluate these programs in other populations, including whether the programs result in cost savings for patients and insurers.