Evaluation of Specialized Medication Packaging Combined With Medication Therapy Management

Abstract

Background This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients. Research Design A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization. Results Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54–1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI, 1.65–1.89; 12-month cost ratio = 1.84, 95% CI, 1.72–1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups. Conclusions The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

“…47 In a group of Medicaid patients, the combination of specialized medication packaging and telephonic MTM increased medication adherence when compared to usual care. 48 …”

Coming full circle in the measurement of medication adherence: opportunities and implications for health care

“…For example, calendared blister packaging has been proven to improve pharmacy claims-based adherence and persistence rates but these results tell little about individual pill-taking behavior 22. Unfortunately, convenience appears to be inversely correlated with insight into causes of non-adherence.…”

Medication Nonadherence, Health Care Utilization, and SafeMed Care Transitions Model Impact in Super-Utilizers

“…Given the magnitude and clinical importance of medication nonadherence in this population, a more collaborative and holistic approach may be needed to improve adherence in this high-risk population, who experience frequent care transitions exposing them to higher drug therapy problems and medication discrepancies. Medication management interventions conducted on other populations have demonstrated mixed results, 17,19,44,45 and care transitions programs targeting super-utilizers have not primarily focused on medication management. 65,91 For instance, Pringle and colleagues evaluated the impact of a large-scale, pharmacy-based intervention on five chronic medication classes among Medicare, Medicaid, or commercial patients and found that, compared to the control group, the intervention group had improved adherence for all medication classes.…”

“…Successful medication management interventions have used multiple strategies, including pharmacist-provided medication therapy management, specialized medication packaging, motivational strategies, and telemonitoring, among others. 1, 40,43,44 However, targeting interventions to patients with multiple chronic conditions, complex medication regimens, and high health care utilization, needs a comprehensive multimodal approach that can address patient and system-level barriers to achieving optimal medication adherence. In our prior work, we found that during care transitions processes from the hospital to the community setting, super-utilizers were at high risk for drug therapy problems and medication discrepancies, which may result in poor adherence.…”

“…The study findings showed a significant improvement in medication adherence in the program cohort compared to controls; however, the effect on health care utilization and health care costs did not vary between the two groups. 44 Additionally, Martin and colleagues examined the effectiveness of community-based, multimedia interventions on medication adherence among low-income rural residents with hypertension and found that medication adherence did not differ significantly from individuals in the control group.…”