Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization
Objectives: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified.
Methods: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified.
Results: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not.
Conclusions: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.
Steinman MA, Seth Landefeld C, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516-1523. https://doi.org/10.1111/j.1532-5415.2006.00889.x
Zelko E, Klemenc-Ketis Z, Tusek-Bunc K. Medication adherence in elderly with polypharmacy living at home: a systematic review of existing studies. Mater Sociomed. 2016;28(2):129-132. https://doi.org/10.5455/msm.2016.28.129-132
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002-2012. https://doi.org/10.1056/NEJMsa1103053
Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med. 2007;147(11):755-765. https://doi.org/10.7326/0003-4819-147-11-200712040-00006
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20(4):317-323. https://doi.org/10.1111/j.1525-1497.2005.30390.x
Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger DL, Shu K, Federico F, Leape LL, Bates DW. Adverse drug events in ambulatory care. N Engl J Med. 2003;348(16):1556-1564. https://doi.org/10.1056/NEJMsa020703
Sarkar U, López A, Maselli JH, Gonzales R. Adverse drug events in U.S. adult ambulatory medical care.. Health Serv Res. 2011;46(5):1517-1533. https://doi.org/10.1111/j.1475-6773.2011.01269.x
Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045-1051. https://doi.org/10.1016/0895-4356(92)90144-C
Witry MJ, Doucette WR, Gainer KL. Evaluation of the pharmaceutical case management program implemented in a private sector health plan. J Am Pharm Assoc (2003). 2011;51(5):631-635. https://doi.org/10.1331/JAPhA.2011.09137
McDonough RP, Doucette WR. Drug therapy management: an empirical report of drug therapy problems, pharmacists' interventions, and results of pharmacists' actions. J Am Pharm Assoc (2003). 2003;43(4):511-518. https://doi.org/10.1331/154434503322226266
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. https://doi.org/10.1056/NEJMra050100
Association NCP. Medication Adherence in America: A National Report Card http://www.ncpa.co/adherence/AdherenceReportCard_Full.pdf (accessed Oct 6, 2015).
Watson LL, Bluml BM. Pharmacy’s Appointment Based Model: Implementation Guide for Pharmacy Practice. Washington, DC: APhA Foundation;2013.
Holdford DA, Inocencio TJ. Adherence and persistence associated with an appointment-based medication synchronization program. J Am Pharm Assoc (2003). 2013;53(6):576-583. https://doi.org/10.1331/JAPhA.2013.13082
Holdford DA, Saxena K. Impact of appointment-based Medication Synchronization on existing users of Chronic Medications. J Manag Care Spec Pharm. 2015;21(8):662-669. https://doi.org/10.18553/jmcp.2015.21.8.662
Andrews S, Marcy T, Osborn B, Planas L. The impact of an appointment‐based medication synchronization programme on chronic medication adherence in an adult community pharmacy population. J Clin Pharm Ther. 2017;42(4):461-466. https://doi.org/10.1111/jcpt.12533
Krumme AA, Isaman DL, Stolpe SF, Dougherty S, Choudhry NK. Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs. Am J Manag Care. 2016;22(3):179-186.
Witry M. Appointment-Based Models and Medication Synchronization: Silver Bullet for Adherence or One Piece of the Puzzle? J Manag Care Spec Pharm. 2015;21(8):714. https://doi.org/10.18553/jmcp.2015.21.8.714
Girdish C, Shrank W, Freytag S, Chen D, Gebhard D, Bunton A, Choudhry N, Polinski J. The impact of a retail prescription synchronization program on medication adherence. J Am Pharm Assoc (2003). 2017;57(5):579-584. https://doi.org/10.1016/j.japh.2017.05.016
Krumme AA, Glynn RJ, Schneeweiss S, Gagne JJ, Dougherty JS, Brill G, Choudhry NK. Medication Synchronization Programs Improve Adherence To Cardiovascular Medications And Health Care Use. Health Aff (Millwood). 2018;37(1):125-133. https://doi.org/10.1377/hlthaff.2017.0881
Didonato KL, Vetter KR, Liu Y, May JR, Hartwig M. Examining the effect of a medciation synchronization or an education program on health outcomes of hypertensive patients in a community pharmacy setting. Innov Phar. 2014;5(3):175.
Hinson JL, Garofoli GK, Elswick BM. The impact of medication synchronization on quality care criteria in an independent community pharmacy. J Am Pharm Assoc (2003). 2017;57(2):236-240. https://doi.org/10.1016/j.japh.2016.11.008
Nguyen E, Sobieraj D. The impact of appointment‐based medication synchronization on medication taking behaviour and health outcomes: A systematic review. J Clin Pharm Ther. 2017;42(4):404-413. https://doi.org/10.1111/jcpt.12554
Patti M, Renfro CP, Posey R, Wu G, Turner K, Ferreri SP. Systematic review of medication synchronization in community pharmacy practice. Res Social Adm Pharm. 2018 [ahead of print]. https://doi.org/10.1016/j.sapharm.2018.11.008
Patterson J, Holdford D. Understanding the dissemination of appointment-based synchronization models using the CFIR framework. Res Social Adm Pharm. 2017;13(5):914-921. https://doi.org/10.1016/j.sapharm.2017.05.022
Witry M, Hoang T. Community Pharmacist Attitudes on Medication Synchronization Programs. Inov Pharm. 2017;8(2).
Witry MJ, Doucette WR. Community pharmacists, medication monitoring, and the routine nature of refills: a qualitative study. J Am Pharm Assoc (2003). 2014;54(6):594-603. https://doi.org/10.1331/JAPhA.2014.14065
Andreski M, Myers M, Gainer K, Pudlo A. The Iowa new practice model: Advancing technician roles to increase pharmacists' time to provide patient care services. J Am Pharm Assoc (2003). 2018;58(3):268-274. https://doi.org/10.1016/j.japh.2018.02.005
Goedken AM, Butler CM, McDonough RP, Deninger MJ, Doucette WR. Continuous Medication Monitoring (CoMM): A foundational model to support the clinical work community pharmacists. Res Social Adm Pharm. 2018;14(1):106-111. https://doi.org/10.1016/j.sapharm.2016.12.008
Doucette WR, Farris KB, Youland KM, Newland BA, Egerton SJ, Barnes JM. Development of the Drug Adherence Work-up (DRAW) tool. J Am Pharm Assoc (2003). 2012;52(6):e199-e204. https://doi.org/10.1331/JAPhA.2012.12001
The American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616-631. https://doi.org/10.1111/j.1532-5415.2012.03923.x
Luder HR, Kunze N, Heaton PC, Frede SM. An appointment-based model to systematically assess and administer vaccinations. J Am Pharm Assoc (2003). 2018;58(3):290-295. https://doi.org/10.1016/j.japh.2018.02.010
McDonough RP, Doucette WR.. Using personal selling skills to promote pharmacy services. J Am Pharm Assoc (2003). 2003;43(3):363-372. https://doi.org/10.1331/154434503321831076
Renfro CP, Patti M, Ballou JM, Ferreri SP. Development of a medication synchronization common language for community pharmacies. J Am Pharm Assoc (2003). 2018;58(5):515-521. https://doi.org/10.1016/j.japh.2018.04.032
Barnes B, Hincapie AL, Luder H, Kirby J, Frede S, Heaton PC. Appointment-based models: A comparison of three model designs in a large chain community pharmacy setting. J Am Pharm Assoc (2003). 2018;58(2):156-162. https://doi.org/10.1016/j.japh.2018.01.005
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