Andrew W. Roberts

The Effect of Community Pharmacy–Based Interventions on Patient Health Outcomes A Systematic Review

Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings.

Patterns of Medication Adherence and Health Care Utilization Among Patients With Chronic Disease Who Were Enrolled in a Pharmacy Assistance Program

BACKGROUND Poor medication adherence due to high drug costs is a barrier to optimal health outcomes among low-income uninsured patients with chronic conditions. Charitable pharmacy assistance programs provide medications to such patients, but little is known about the utilization patterns of program participants. METHODS We used a retrospective cohort design to investigate 6-month outcomes for participants in the University of North Carolina (UNC) Health Care Pharmacy Assistance Program (PAP) who received medications indicated for hypertension, diabetes, and/or hyperlipidemia from 2009 through 2011. Logistic regression was used to analyze predictors of medication adherence and to evaluate the association between adherence and use of emergency and inpatient care. RESULTS The 3 study cohorts included 866 patients receiving antihypertensive agents, 265 patients receiving oral glucose-lowering agents, and 455 patients receiving statins. When assessed 6 months after program enrollment, 52%, 45%, and 38% of patients in these 3 groups, respectively, were at least 80% adherent to treatment. Adherent patients in all cohorts had lower odds of requiring inpatient or emergency department care, but the decrease was only statistically significant among those taking antihypertensive agents (odds ratio for hospitalization = 0.58; 95% confidence interval, 0.39-0.87). LIMITATIONS Selection bias and inability to capture utilization data from sources other than UNC Health Care may have biased results. CONCLUSION Approximately 50% of PAP participants were adherent to chronic disease medications. Adherence to such therapies among patients who are receiving financial assistance with medications may reduce their need for costly health care services. Future research should assess the long-term ability of pharmacy assistance programs to promote medication adherence and should examine alternative strategies for improving adherence and health outcomes among low-income uninsured patients.

Revisiting the washout period in the incident user study design: why 6–12 months may not be sufficient

AIMS The purpose of this study was to describe how washout period duration affects the size and accuracy of retrospective incident user cohorts. MATERIALS & METHODS MarketScan commercial claims data from 2007 to 2010 were used and included adults with an antihyperlipidemic, antidiabetic or antidepressant claim in 2010. Incident user cohorts using 3-, 6-, 12-, 24- and 36-month washouts were created and changes in sample size and incident user misclassification were described. RESULTS & CONCLUSION The 6- and 12-month washouts excluded 75 and 85% of the samples, respectively. Half of subjects in the 6-month washout cohorts were actually prevalent users, and the 12-month washout period resulted in 30% misclassified. Using common washout periods of 6-12 months may insufficiently address prevalent user bias in large commercial claims databases.

Lock-In Programs and the Opioid Epidemic: A Call for Evidence

The authors discuss an opioid epidemic in America in relation to the U.S. Comprehensive Addiction and Recovery Act (CARA) which was passed in 2016 and contains a provision implementing drug management programs for at-risk beneficiaries (lock-in programs or LIPs) in Medicare Part D prescription drug plans beginning in January 2019. American public health interventions and drug overdose rates are examined, along with education and other services that are contained in LIPs.

The University of North Carolina's Health Care Pharmacy Assistance Progam.

BACKGROUND UNC Health Care has a Pharmacy Assistance Program (PAP) that provides financial assistance to uninsured patients in North Carolina who need prescription medications. Despite significant investment in the program, little is known about the patients accessing it or the specific health care services they use. Our objectives were to describe the PAP population, to examine their use of prescription medications and health services, and to characterize changes in prescription medication use and expenditures from 2009 through 2011. METHODS We used a repeated cross-sectional study design, merging prescription claims with health records from Carolina Data Warehouse for Health, to measure use of prescription medications and use of inpatient, outpatient, and emergency department care by PAP participants. Prescription claims were grouped into therapeutic categories. We generated descriptive statistics for key variables to examine health service utilization from 2009 through 2011. RESULTS From 2009 through 2011, PAP served 7,180 patients from 81 counties in North Carolina. PAP users received a mean of 23 prescriptions, at an average cost of

Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy

754 per recipient per year. An average of

Assessing the present state and potential of medicaid controlled substance lock-in programs

2.93 million per year was spent on the program, with an 8% rise in spending from 2009 to 2011. Inpatient care and emergency department care were utilized by 30% and 31% of PAP users, respectively, and there was minimal change in these rates over 3 years. LIMITATIONS Data were limited to medications dispensed through PAP and to health services provided by UNC Health Care. CONCLUSION With the state’s decision to not expand Medicaid, PAP will continue to be an important resource for North Carolina’s low-income citizens.