Impact of the SIMPL-SYNC Refill Synchronization Program on medication adherence: A pragmatic randomized controlled trial

Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence

BACKGROUND

Traditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments.

OBJECTIVES

To describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation.

METHODS

In September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp.

RESULTS

Analysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%).

CONCLUSION

The ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.

Evaluation of a medication safety and adherence program within a First Nations community in Saskatchewan, Canada

OBJECTIVE

The objective of this mixed methods report was to describe a pharmacist intervention to support medication adherence of patients living with chronic health conditions in a First Nations community.

SETTING

The intervention took place in a First Nations community health center.

PRACTICE DESCRIPTION

Multidisciplinary primary care clinic.

PRACTICE INNOVATION

A pharmacist was integrated into the weekly primary care clinics to regularly monitor patients and address any medication-related issues.

EVALUATION

The pharmacist intervention was evaluated qualitatively by using focus groups and interviews, and quantitatively by analyzing medication refill claims.

RESULTS

The entire health care team believed that the support provided by the pharmacist encouraged the patients to take control of their health conditions and was beneficial to increasing patient self-management behaviors, including improved medication adherence. All staff appreciated the team-based model because it optimized appointment times and promoted better patient care. The patients valued having a pharmacist they trusted and with whom they had a relationship to address their concerns. In the 6 months after the date of the initial visit with the pharmacist, the median number of refill claims increased in comparison with the 6 months before.

CONCLUSION

A clinical pharmacist contributes to improved satisfaction and medication adherence when integrated into a primary care team providing care in a First Nations community.