Improper prescription drug use costs health care system $100B

Pills in handPatients who fail to follow their prescribed treatments cost the U.S. health care system an estimated $100 billion annually.

But community pharmacists and insurance benefit managers, working together, can help, according to a College of Pharmacy study.

“Medications are essential in treating diseases, preventing hospitalizations and improving quality of life, but patients often under-utilize them,” says Daniel Touchette, assistant professor of pharmacy practice and lead researcher for the study.

The cost, number of medications, length and complexity of treatment regimens — and difficulty remembering — are just some of the factors that contribute to patients taking their drugs improperly, he said.

“Omission gaps,” when a patient who should be taking a drug is not taking it at all, are also common, Touchette said.

Such lapses, which have been shown to increase sickness, can even be deadly and have greater potential to cause harm than unwarranted prescribing, Touchette said.

Touchette and Glen Stettin, senior vice president of clinical research at Express Scripts Inc., one of the largest pharmacy benefit companies in the U.S., sought to determine whether community pharmacists could help patients stick to their medication schedules.

In a 90-day study at almost 100 community pharmacies in Illinois, nearly 2,500 patients with diabetes, hypertension, high blood pressure or heart failure were followed. All were state employees enrolled in a state health insurance plan who had gaps in their therapy.

They were encouraged to visit their pharmacist during the initial appointment, with follow-up in-person or by telephone.

Some pharmacists received case-based training focused on disease management and motivational communication, then were notified by computer with alerts from the pharmacy benefits manager. Another group of pharmacists did not.

The computer sent the pharmacies an alert whenever a gap in care occurred. Pharmacists contacted the patient and notified the patient’s primary care provider.

Pharmacists who received computer alerts from the benefits manager had closed 55.5 percent of patient-care gaps within 30 days, compared to the 50.6 percent closed by the control group of pharmacists who did not receive the alerts. After 60 days, the difference between the two pharmacist groups had narrowed to 66.1 percent versus 65.2 percent.

“Pharmacists are in an optimal position to address therapeutic gaps in care,” said Touchette.

“Community pharmacists are knowledgeable about potential barriers and solutions to adherence issues. They have frequent contact with their patients, know them well, and when needed, reach out to physicians on their behalf.

“They are also widely considered a trusted source for providing information to patients and practitioners about medication therapies.”

The study is published in the American Journal of Managed Care and was funded by Express Scripts.

Other authors are graduate students Sapna Rao and Weihan Zhao, Purna Dhru and Inderpal Bhandari of Express Scripts, and the late Young-Ku Choi, a biostatistician in the Institute for Health Research and Policy.

samhos@uic.edu

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