Pharmacist interventions boost adherence for minorities

Pharmacist intervention is one primary way that adherence to cholesterol-lowering medications can be improved in minority neighborhoods, a recent study found.

The study, a collaboration between Walgreens and the University of Chicago, suggests that pharmacy interventions and benefit-plan designs with low co-pays could be key factors in helping to improve adherence to statin medications for patients in predominantly African-American and Hispanic neighborhoods.

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“Adherence to medications for chronic conditions such as high cholesterol is critical to the prevention of unnecessary hospitalizations and better heart health outcomes for patients,” said Michael Taitel, PhD, study co-author and senior director of health analytics, research and reporting for Walgreens.

Improved medication adherence was associated with several variables, including co-pays under $10, the use of 90-day refills, and whether a patient had a health plan (or “payer”) other than Medicaid.    
 
In the study published in the Journal of Racial and Ethnic Health Disparities, researchers compared adherence rates for more than 300,000 patients. They focused on patients filling new prescriptions for statin medications at Walgreens pharmacies in mostly minority communities, compared to those filling the same prescriptions at Walgreens in mainly Caucasian neighborhoods.

In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in African-American and Hispanic neighborhoods had two to three weeks less statin therapy over a one-year time period – a significant difference.

Patients living in block groups with at least 50% black residency tended to be younger, female, have lower co-pays, use more Medicaid, have lower incomes, and be less educated, compared to patients living in neighborhoods with lower proportions of black residents. A similar pattern was seen for patients residing in majority Hispanic block groups. 

“Our study demonstrates that lower adherence in largely minority neighborhoods is a significant challenge, and suggests that community pharmacies can play a role in helping to address it,” Taitel said. “The data will be helpful for all stakeholders in developing, implementing and measuring programs and strategies designed to improve adherence among these patients.”

Patients who have participated in brief face-to-face counseling sessions with a community pharmacist at the beginning of statin therapy demonstrate greater medication adherence and persistency, and more aggressive and tailored approaches to improve adherence are beginning to be explored, the researchers said.

“Neighborhood pharmacies located in minority neighborhoods are potentially well-positioned to serve as the locus for community-level interventions designed to improve health, not only through appropriate stocking and staffing and tailored adherence programs but also through direct patient services,” they wrote.

Pharmacist interventions with patients at risk for low adherence across several medication classes – including statins – have been shown to improve adherence and lower health care costs.  
  
Previous research has shown that the lower adherence to cardiovascular medications among African-American and Hispanic patients likely contributes to a persistent seven-year lower overall life expectancy relative to Caucasians.