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Adherence key to outcomes

BY Michael Johnsen

Community pharmacists can dramatically help their patients stick to their prescription regimens, according to a new study led by researchers at the University of Pittsburgh School of Pharmacy. The findings, reported in August in Health Affairs, also suggest that greater adherence to medications can lead to a reduction in emergency room visits and hospital admissions, thereby lowering healthcare costs for a variety of chronic conditions, including diabetes and asthma.

(For the full Diabetes Report, including charts and additional coverage, click here.)

For the study — dubbed the Pennsylvania Project — staff from Pitt’s School of Pharmacy’s Program Evaluation and Research Unit (PERU) trained 283 community pharmacists to ask customers a few quick questions about medication adherence using established survey tools. They also were taught to have a brief dialog with patients whose screening scores indicated they were at risk of not taking their medications as prescribed by their doctors.

During 2011, 29,042 people had prescriptions filled at 107 Rite Aid pharmacies that implemented the screening and brief intervention approach (SBI), and 30,454 people who went to 111 “control” pharmacies that didn’t use SBI.

For the five classes of common medications the researchers reviewed, PDC rates of 80% or better increased in the SBI group during the intervention compared with the control group, ranging from 3.1% for beta blockers to treat high blood pressure to 4.8% for oral diabetes drugs. Healthcare costs dropped by $341 annually per person for SBI patients taking oral diabetes drugs and by $241 for SBI patients taking statins to lower cholesterol.

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Diabetic treatment key for Star ratings

BY Michael Johnsen

Thanks to the Centers for Medicare and Medicaid Services’ Five-Star Quality Rating System, the diabetes community stands to play a significant role in how pharmacies think about their patients and their medication adherence programs. While successfully managing the outcomes of a diabetes patient has served as a proof of concept around pharmacy’s role in saving healthcare dollars, going forward proficiency in managing diabetes patients will become a key component in the success of individual pharmacies.

(For the full Diabetes Report, including charts and additional coverage, click here.)

“Inside of the Star ratings, there are two of the five clinical measures that … are directly correlated to diabetes care,” Samuel Stolpe, director of quality strategies for the Pharmacy Quality Alliance, told DSN. “One of those is around medication adherence for oral antidiabetic medication that doesn’t include insulin, [and] the other is for the appropriate treatment of hypertension in patients with diabetes,” he said. Looking ahead, CMS is considering adding a measure around oral antidiabetic medicine dosing to the Star ratings system, Stolpe said.

According to Stolpe, the Star ratings are going to become a bigger influencer going forward, especially as the industry develops a pharmacy Star metric that will have a public element, and certain health plans experiment with pay-for-performance models to incentivize higher Star ratings among pharmacies. “Diabetes is definitely a focus for those pharmacists and pharmacies that are looking to perform well on emerging incentive and disincentive programs that payers will be rolling out in 2015,” Stolpe said.

PQA currently is in the process of working on Pharmacy Quality Ratings, thanks to a grant from the Community Pharmacy Foundation. “Right now, hospitals, physicians, nursing home facilities — they’re all getting rated,” he said. But pharmacies aren’t. “We’re very focused on making sure that this is going to be fair. Right now, it doesn’t have a public-facing element. We’re figuring out ways of doing it in a beta test.”

When that public-facing element becomes available, patients will be able to choose pharmacies based on their performance in successfully managing diabetes patients. That will create a reinforcing loop, where patients interested in better managing their diabetes gravitate toward pharmacies proficient in managing diabetes.

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Managing chronic conditions at retail

BY Michael Johnsen

Managing such chronic conditions as diabetes has become a core competency among many retail pharmacies. It dovetails well with the retail pharmacy industry’s goal to become a destination center for patients proactively seeking to improve their health and wellness.

(For the full Diabetes Report, including charts and additional coverage, click here.)

A good example of a retail program that speaks directly to the diabetes patient is Rite Aid’s Health Alliance initiative.

The Rite Aid Health Alliance employs a team approach with pharmacists, physicians and specially-trained in-store health coaches — all endeavoring to help patients with polychronic and chronic conditions meet certain health-related goals central to improving outcomes. The care team members collaborate with the patient to establish health goals, eliminate barriers and create a personalized healthcare action plan in coordination with the patient’s physician.

“By putting our care coaches in the middle of that care team (i.e., pharmacist and physician), we’re able to more effectively help these folks manage their disease states, improve their compliance and improve their health overall,” Ken Martindale, president and COO of Rite Aid, told DSN. “The results have been very encouraging. As I travel the markets and talk to these care coaches … the feedback we’re getting back from patients is phenomenal. They’re not used to having this kind of personal attention and someone they can really count on to help them in-between their physician appointments [and] actually work through the things that they need to do to live a healthier lifestyle.”

Rite Aid Health Alliance has partnerships with providers in Southern California, New York, North Carolina and Pennsylvania.

Walgreens also is collaborating with healthcare systems to reach and serve patients with such chronic conditions as diabetes. For example, this summer the chain collaborated with CHE Trinity Health to improve the care of its patients after they were discharged from the hospital. That partnership included bedside medication delivery and a medication counseling service. “Medication non-compliance is a major reason for readmission to the hospital, especially for patients with chronic conditions, such as heart failure and diabetes,” said Lourdes Health System president and CEO Alexander Hatala. “Working with patients before they leave the hospital and after they are discharged will help ensure patients obtain, understand and take the medicines that are an important part of their health.”

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