resize_shutterstock_484138195Patients receiving psychiatric services at community mental health centers (CMHCs) are often prescribed medication that is critical to the treatment of behavioral health conditions, including schizophrenia, bipolar disorder, anxiety, and depression. Previous studies have shown correlation between rates of medication adherence and risk of hospitalization, but potential differences in medication adherence and other outcomes for patients of CMHCs by specific pharmacy type have not been widely studied1, 2.

Poor adherence to prescribed medication is widely recognized as a major determinant of poor outcomes across all disease categories.1-4 Patients with behavioral health diagnoses are particularly prone to nonadherence to psychiatric and other medication classes.5-9 Nonadherence to medication has been linked to increased use of health care services, including increased hospitalizations and use of emergency department (ED) services.10-13 Thus, nonadherence to prescribed medication is a risk factor for worsening illness status, diminished function, and increased health care expenditures.

The reasons why patients do not comply with medications as prescribed include such factors as denial of illness, cost of the medication, relationship with prescribers, physical barriers to obtaining the medication, comorbid substance use, and adverse side effects, among others (e.g., complexity of the medication regimen).4,13-16 Pharmacies that operate on-site within clinics may help reduce these barriers, primarily by addressing the physical barriers to obtaining medication, but potentially via other means, such as embedding a pharmacist into the clinical care team. It should be noted that in this study the physical location of the pharmacy, whether in or out of the clinic, is the primary distinguishing characteristic between pharmacies compared, but other factors may affect differences in adherence rates and outcomes, such as services offered and interventions performed.

The authors of this study1 examined the potential benefits of placing a pharmacy within a mental health service delivery setting on both adherence to psychiatric medication prescribed and health outcomes. They compared these outcomes between patients who filled their prescriptions at the pharmacy located within the community mental health center (CMHC) in which they received care and those who filled their prescriptions at pharmacies outside of their CMHC. The authors examined data from more than 2,500 patients of two community health centers in Michigan, comparing medication adherence and outcomes between patients who used Genoa pharmacies (mental health provider pharmacy) and those who used community pharmacies. The study1, 2 showed that Genoa patients had:

  • A 96% medication adherence rate vs. 82% for the control group (P<0.001)
  • A 40% lower rate of behavioral health-related hospitalization
  • An 18% lower rate of behavioral health–related ED visits

Cost avoidance was $58 per Genoa member per month based on hospitalizations and emergency department visits, for a total estimated savings of $230,000 during the 13-month period examined.

The authors concluded that the physical proximity to the source of prescription medication is a potentially important factor in whether a patient is adherent to a prescribed medication and removing a physical barrier to obtaining medication may be a mediating factor for improved adherence and decreased need for other expensive health care services1. The study demonstrates that placing pharmacists on interdisciplinary care team helps to address these factors, Dr. Odorzynski said. “It’s not just the fact that we’re on site and convenient; it’s also the fact that the pharmacist is really collaborating with the other care providers. These patients are taking very complex medication regimens and the pharmacist is often their primary contact.”2

Readers of this blog are highly encouraged to review the complete information found in the links and references provided below. Additionally, interested parties can find additional information on this subject in the public domain.

Links/References:

  1. http://www.jmcp.org/doi/full/10.18553/jmcp.2016.16004
  2. http://www.pharmacypracticenews.com/Operations-and-Management/Article/09-16/On-Site-Pharmacists-Show-Worth-in-Mental-Health/37855
  3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028-35.
  4. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14):2101-07.
  5. Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005; 29(7):1190-97.
  6. Worth TE. Medication adherence strategies: we can do better. Am J Nursing. 2010; 110(4):15.
  7. Grenard JL, Munjas BA, Adams JL, et al. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med. 2011;26(10):1175-82.
  8. Grodensky CA, Golin CE, Ochtera RD, Turner BJ. Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases. J Stud Alcohol Drugs. 2012; 73(6):899-910.
  9. Heaton PC, Tundia NL, Luder HR. U.S. emergency departments visits resulting from poor medication adherence: 2005-07. J Am Pharm Assoc. 2013; 53(5):513-19.
  10. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43(6):521-30
  11. Butler RJ, Davis TK, Johnson WG, Gardner HH. Effects of non-adherence with prescription drugs among older adults. Am J Manag Care. 2011; 17(2):153-60.
  12. Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014; 7:35-44.
  13. Bardel A, Wallander MA, Svärdsudd K. Factors associated with adherence to drug therapy: a population-based study. Eur J Clin Pharmacol. 2007;63(3):307-14.
  14. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011; 86(4):304-14.
  15. Welty TE, Willis SL, Welty EA. Effect of limited transportation on medication adherence in patients with epilepsy. J Am Pharm Assoc (2003). 2010; 50(6):698-703.
  16. Wroth TH, Pathman DE. Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med. 2006; 19(5):478-86.