Evaluating the Effects of a Medication Adherence Packaging Program on Outcomes in Older People

Abstract

Objective To determine the impact of an adherence packaging and medication synchronization program on hospital visits for older people living independently in the community. Design A retrospective pre-post study that evaluated patient outcomes over a 24-month period was conducted. Patient-specific socio-demographic, medical, and hospital visit-related data were collected for 12 months before and after patient enrollment in the adherence packaging program. Setting The study was conducted at Rx Partners LTC, LLC, a University of Pittsburgh Medical Center (UPMC) pharmacy in Pittsburgh, Pennsylvania. Participants Patients 65 years of age or older, of any gender, with UPMC Health Plan insurance coverage, who enrolled in the adherence packaging program between July 2019 and December 2019. Intervention Enrollment in the adherence packaging program included medication synchronization and packaging in prefilled medication sets delivered to the patient’s home monthly. Monthly medication reconciliation and review by clinical pharmacists was an included value-added service. Results Of the 92 patients included in the analysis, 60 had hospital visits during their pre-enrollment period for a total of 146 visits, compared with 54 patients in the postenrollment period totaling 126 visits; however, the mean rate of hospital visits was not statistically significant (1.59 versus 1.37; P = 0.48). Pharmacists prevented 1.87 medication errors/patient in the postenrollment setting. Conclusion Enrollment in the program was associated with fewer hospital visits, though not statistically significant, and pharmacists had abundant opportunity to prevent medication errors and optimize regimens. Further evaluation is warranted in a larger cohort.

Systematic review of the impact of medication synchronization on healthcare utilization, economic, clinical, and humanistic outcomes

“…40 This study found a reduction in emergency department visits accounted for most of the hospital visit-related benefit for this program, with a risk reduction of 33% after enrollment, but a minimal change in unplanned hospitalizations occurred. 40 Conversely, a study of pharmacies in Maine did not find any significant differences in cost savings for either medical or pharmacy costs in Medicare Advantage (MA-PD) patients taking statin, renin-angiotensin system antagonist (RASA), or noninsulin diabetes medications. 33 For pharmacy utilization, in a study of Midwest pharmacies, there was an increase in the number of fills by 9%-19% from 6-month premed-sync enrollment period to 6-month post-med-sync enrollment period for patients on diabetes, hypertension, and hyperlipidemia medications.…”

“…Of the 27 studies, 26 were observational and had moderate to serious bias due to confounding and bias in selection of participants for the study (Table B1). 7,10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][43][44][45][46][47] All the non-randomized studies had a moderate bias in measurement of outcomes, while two studies had serious bias in measurement of outcomes. 42,48 Confounding was commonly seen as most of the med-sync programs were in conjunction with other programs, such as Medication Therapy Management (MTM), home delivery services, medication reconciliation, adherence packaging, or educational interventions.…”

“…Characteristics of included studies are provided in Table C1. Study designs varied, with 1 (4%) randomized controlled trial, 24 3 (11%) quasi‐experimental studies, 7,25,26 10 (41%) retrospective cohort studies, 27–36 4 (15%) pre‐post studies, 37–40 1 (4%) prospective cohort study, 41 1 (4%) cost–benefit analysis, 42 6 (19%) cross‐sectional surveys, 43–48 and 1 (4%) chart review 10 . Med‐sync was provided at different pharmacy settings, such as independent, chain, outpatient, and mail‐order pharmacies.…”

“…There were studies that measured only utilization (n = 3), 26,[34][35][36]40,41,43,44 costs (n = 1), 42 or both costs and utilization (n = 1). 33,36 Utilizations were measured as hospital admissions, 40 readmissions, 36 emergency department visits, 40 pharmacy prescription fills/volume, 26,33,44 number of visits to the pharmacy, 35 and vaccination administration.…”

“…There were studies that measured only utilization (n = 3), 26,[34][35][36]40,41,43,44 costs (n = 1), 42 or both costs and utilization (n = 1). 33,36 Utilizations were measured as hospital admissions, 40 readmissions, 36 emergency department visits, 40 pharmacy prescription fills/volume, 26,33,44 number of visits to the pharmacy, 35 and vaccination administration. 41,43 One study of the Access Program involving medication reconciliation, med-sync, and home visits showed a 76% reduction in 30-day hospital readmission rates, reducing readmissions from the national average of 17.3 readmissions per 100 patients to 4.1 per 100 patients.…”