OBJECTIVE: To evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending.
DESIGN: Quasi-experimental difference-in-difference analysis with a nonequivalent control group.
SETTING AND PARTICIPANTS: Eligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016. A control group was propensity score-matched. Interventions consisted of enhanced services and a more intensive, comprehensive initial pharmacy assessment (CIPA).
OUTCOME MEASURES: Outcomes included hospitalizations; emergency department (ED) visits; health care spending for total medical, inpatient, outpatient, and ED services; and adherence to renin-angiotensin system antagonists (RASA), statins, noninsulin diabetes medications (NIDM), and multiple medications for chronic conditions (MMCC).
RESULTS: There were 31,509 patients who met eligibility criteria and were attributed to a participating pharmacy. Of these, 3897 received a CIPA. Before matching, patients attributed to participating pharmacies had greater Medicaid enrollment through aged, blind, or disabled status (49.2% vs. 31.5%, P < 0.001); greater case management (10.3% vs. 7%, P < 0.001); and worse rates of chronic disease (P < 0.001). Successful matching removed these differences. Adherence to RASA medications and MMCC increased by 9.5% and 10.3% (P < 0.05), respectively. Adherence did not change for statins and NIDM. The analysis also revealed a slower decline in average total medical spending of 5.7% (P < 0.01) relative to the control group over the same period, owed to a 9.6% (P < 0.001) slower decline in outpatient spending. ED utilization also decreased more slowly relative to controls by 4.8% (P < 0.05) following the intervention.
CONCLUSION: The pharmacy intervention resulted in a statistically significant improvement in medication adherence to RASA and multiple chronic medications, but did not change or may have worsened utilization and spending outcomes. More research is needed to explore patient selection and variation in implementation and heterogeneity of treatment effects when evaluating pharmacy interventions.
Bibliographical noteFunding Information:
The authors thank the contribution of Trista Pfeiffenberger to the design of the project and Neepa Ray and Charles Shasky to the analysis. Disclosure: Troy K. Trygstad is the Vice President of Pharmacy Programs for Community Care of North Carolina and Executive Director of Community Pharmacy Enhanced Services Network USA, LLC, 2 companies which were involved in the creation of the enhanced services pharmacy network described in this study. The other authors declare no relevant conflicts of interest or financial relationships. Funding: The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (1C12013003897). The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
© 2020 American Pharmacists Association®
PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.