Impact Of Refill Synchronization On Medication Adherence For Chronic Diseases
Objectives: The objective of this study is to assess the impact of medication synchronization (med sync) on medication adherence for three drug classes under the CMS Star Rating system i.e. oral diabetes, hypertension and cholesterol. Methods: A quasi-experimental pre-post study design was employed using pharmacy prescription fill data from various independent community pharmacies located in different regions of Mississippi. Using Proportion of Days Covered (PDC), medication adherence before and after the med sync was calculated. Total study period of one year for each patient including six months of pre-period and post-period was used for the analysis. Descriptive statistics were calculated. Wilcoxon-Signed Rank test was performed to compare the pre-period adherence to post-period adherence. Proportion of adherent patients before and after the med sync were also compared using McNemar’s Exact Test. Using the obtained 2x2 contingency table odds ratio of being adherent in post-period as compared to pre-period was calculated. Results: A total of 56, 89 and 77 patients were found to meet the inclusion/exclusion criteria in diabetes, hypertension and cholesterol drug categories, respectively. The approximate average age of the patients for the three drug classes was as follows: diabetes 66 years (23-87 years, ± 11.03), hypertension: 70 years (41-101 years, ± 11.53) and cholesterol: 67 years (40-100 years, ± 11.85). Majority of the study sample belonged to 60-80 years of age and had PDC values ranging from 90-100 in both pre-period and post-period for all the three drug classes. Average post-period PDC (0.99) was higher than average pre-period PDC (0.94) and was also statistically different from each other for all the three drug classes. Increase in the proportion of adherent patients from pre-period to post-period was witnessed for the three drug classes i.e., diabetes (91.07% to 100%), hypertension (89.89% to 98.88%) and cholesterol (90.91% to 98.70%). However this increase was only statistically significant for the hypertension drug class (p=0.0215). Also, patients in post-period had higher odds of being adherent in post-period as compared to pre-period for all the three drug classes. Conclusions: The results indicated that after being enrolled in med sync, medication adherence generally improves.
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