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    Three reasons for nonadherence


    Medication synchronization

    This brings us to our study with the University of Pennsylvania. Working together, we evaluated the impact of a pilot refill synchronization program implemented by Humana. We had noticed that while synchronizing medication refills is an increasingly popular strategy to improve medication adherence, little research has been done regarding its effectiveness. A random sample of Medicare Advantage patients receiving mail-order refills for common maintenance medications (antihypertensive, lipid-lowering, or antidiabetic agents) were invited to join the program and followed for twelve months. The study found that synchronizing prescription refills does, in fact, lead to improved adherence for patients taking multiple medications. We demonstrated an absolute increase in the proportion of patients deemed adherent during follow-up of 3 to 10 percentage points for the intervention group, compared to 1 to 5 percentage points for the control group. Patients with poorer baseline adherence showed larger increases in the absolute proportion deemed adherent in intervention (23 to 26 percentage points) compared to a control group (13 to 15 percentage points). In a different, but related study—also conducted with the University of Pennsylvania—we found that synchronized medication schedules were particularly effective for patients filling medications exclusively at retail pharmacies.

    Synchronizing medication refills is an increasingly popular and common strategy to improve medication adherence. However, the interesting point to take away from our research is that synchronizing refills could be a particularly promising intervention to improve adherence to maintenance medications (often taken by people with chronic conditions), especially among Medicare patients with low adherence to start with. In addition, the retail setting for pharmacy refills appears to have an effect on medication adherence. Proximity to patients’ homes and convenience could be contributing factors. This should be investigated further as a strategy for improving medication adherence.

    Get creative and experiment with your solutions

    Medication synchronization is only one approach. Depending on the unique needs of your patient populations, any number of strategies may prove effective in reaching patients in their communities to remind them to take their medications. The key is keeping an open mind. For example, we recently conducted a test in which our members received reminder phone messages from a number of sources (e.g., their pharmacists, their physicians), and a select group received reminder messages from celebrities, including former New Orleans Saints quarterback Bobby Hebert. We found that the combination—calls from the pharmacists and celebrities—had the greatest impact on members.

    Medication adherence is a daunting problem, and one that won’t be solved by any one approach. However, by uncovering the root causes of why patients become nonadherent, staying current with evolving strategies such as medication synchronization, and experimenting with emerging approaches, your organization will be better positioned to improve the lives of patients and reduce costs through improved health outcomes.


    Clay Rhodes, BCPS, BCGP, PharmD, MBA, is director of pharmacy safety programs at Humana.





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