The Economic Impact of a Pharmacy-Based Hybrid Medication Adherence Model in Patients with Metabolic Syndrome.

摘要

Background: Individual pharmacy-based interventions have improved outcomes, but have not solved the ;Objectives: To 1) Describe the implementation, and initial experiences, of a hybrid model of pharmacy care for patients with metabolic syndrome, 2) Study the impact of a hybrid model of pharmacy care on economic outcomes when compared to other community pharmacy models of care in patients with metabolic syndrome. 3) To study the impact of a hybrid model of pharmacy care on adherence to medications targeted by the CMS Five-Star Quality Rating System in patients with metabolic syndrome.;Methods: This is an exploratory pilot of a large, prospective, randomized control study. The hybrid model utilizes an appointment based model to provide adherence blister packaging, Medication Therapy Management (MTM) and refill synchronization. A second group receives adherence packaging and refill synchronization, a third group MTM alone, and a control group receives none of the aforementioned services. Contact between the researcher and participant occurs every three months, alternating between face-to-face and telephonic. All four groups are compared for healthcare cost and utilization, as well as adherence to medications identified by the Centers for Medicare and Medicaid Services (CMS) STAR measures.;Participants were recruited from a local endocrinology practice within an Integrated Delivery Network (IDN), and included adults within a certain health plan selected from a Diabetes Center. Patients were required to have; diabetes, hypertension and hyperlipidemia, and at least one medication for each disease state.;Cost data was obtained via medical and prescription claims. Medication adherence was calculated from the claims data as the proportion of days covered (PDC). Baseline consists of data for the six months prior to enrollment. This is compared, via trend analysis, with data for six months post-enrollment.;Results: Initial economic outcomes showed promising trends in all of the intervention groups. Overall, the hybrid model of care did not experience a change in total costs. This is due to a decrease in medical costs and a concurrent increase in prescription costs.;Discussion: Literature suggests that the trends experienced may lead to prevention of avoidable medical costs and long-term overall savings. Initial trends in medication adherence suggest that the hybrid model of care may have an impact on CMS STAR ratings. This may have policy implications as insurers plan to maximize their STAR ratings. Further study, including the continuation and expansion of the current study, is required to provide evidence to support the provision of the hybrid model of care.