A Pilot Study Exploring the Impact of a Primary Medication Non-Adherence Intervention among Four Chronic Disease States in One Regional Division of a Large Community Pharmacy Chain

Abstract

There is a 12.2% rate of primary medication non-adherence (PMN) among community pharmacy patients. The Pharmacy Quality Alliance (PQA) has developed a standardized definition of PMN to aid stakeholders in addressing PMN. However, little research had been conducted to date on how to address PMN. The objective of the study was to determine the impact of an evidence-based adherence intervention program on PMN rates among four chronic disease states and to identify and characterize factors associated with PMN. Patients at risk of PMN were randomized into a control or intervention group. Those in the intervention group received a live call from a pharmacist to determine reason for and to discuss solutions to overcome PMN. Subjects included adult patients with newly prescribed medications used to treat diabetes, hypertension, hyperlipidemia, and/or chronic obstructive pulmonary disease (COPD). This study occurred in six pharmacies across one regional division of a national supermarket, community pharmacy chain. Prescriptions were considered newly initiated when the same drug, or its generic equivalent, had not been filled during the preceding 180 days. Prescriptions were considered at risk if they had not been obtained by day 7 of it being filled. Prescriptions were considered PMN if the patient had not obtained it, or an appropriate alternative, within 30 days after it was prescribed. During the 4-month intervention period, 203 prescriptions were included in the study with 94 in the intervention group and 109 in the control group. There was a 9% difference (p = 0.193) in PMN between the intervention group (44 patients, 47%) and the control group (61 patients, 56%). The therapeutic class most at risk of PMN was statins (34%). Cost (26%) and confusion/miscommunication (15%) were the most common reasons for PMN within the intervention group. Among the four chronic disease states studied, the intervention had the largest impact on hypertension. The PMN intervention did not significantly decrease PMN rates.