(1175) Medication Review and Outreach in the Uninsured Patient Population with Sub-optimized Medication Adherence

Objectives: A pharmacist’s role in the medication review and dispensing process includes reviewing the prescription for appropriateness and medication adherence. Although this is done routinely in the community pharmacy setting, payers may also institute their own requirements for review, including disease state medication recommendations, comprehensive medication reviews, and additional flags for dosage and duration. For patients who are uninsured, this additional review is not present. However, it is best practice for patients to be subject to periodic comprehensive medication reviews and medication therapy management as these have been shown to improve medication adherence, reduce polypharmacy, and identify potential inappropriate medications.

This project focuses on medication review for a specific group of uninsured patients and tracks interventions initiated by the clinical pharmacist. Comprehensive medication review and fill data will be used to identify patients with medication therapy management needs or insufficient medication adherence. The pharmacist will provide education on medications and disease states while also attempting to address barriers to adherence. Comparisons of adherence and interventions will be made before and after outreach. The goal is to improve adherence rates by identifying gaps in medication reviews and adherence through outreach and interventions for uninsured patients and to identify a workflow to improve these rates.

Methods: Patients will be identified first by their status as Uninsured or Self Pay for their prescription medications at Community Health Association of Spokane (CHAS) Spokane Valley Pharmacy. They will then be pursued for recruitment by analyzing prescription day supply on hand pharmacy statistics. Adherence data will be reviewed with a focus on statin medications and medications for hypertension and diabetes as these medications have been identified as critical to the standards of care for managing their respective chronic diseases. Pre-intervention data collection will be conducted in November-December via profile reviews to assess appropriateness of the candidate. A phone call will then be made in December to patients to introduce the project with an invitation to initiate discussions surrounding their medications as well as the barriers contributing to sub 80% adherence rate. Patients must have been seen by a CHAS provider in the last two years and be taking at least one medication identified as critical for chronic disease state management. Post-intervention data collection will be conducted in February-March. Statistical analysis will be conducted on the data collected before and after this service’s outreach and interventions are completed to assess for effect size on adherence rate. Data will be collected from patients that participated in this service and will be compared to a unique uninsured group from a different pharmacy which would serve as the placebo group.

It was calculated that a sample size of 20 uninsured patients would provide 90% power to demonstrate a 10% absolute rate increase in the prescription adherence in the intervention group with a 95% confidence interval. This is based on a previous meta-analysis of adherence rate effect sizes resultant from behavioral and education interventions conducted with patients receiving prescription medications. On average these interventions led to a 4-11% increase in adherence.

Results: Currently there are 112 Self Pay patients at CHAS Valley Pharmacy. Of those, there are 25 patients with medication adherence under 80%, averaging 63% adherence for diabetes medications, 68% for hypertension medications, and 64% for statin medications.

Conclusions: We estimate a higher rate of medication adherence post intervention, raising the chances for favorable clinical outcomes within this uninsured patient population.