Brantley M. Underwood Pharm.D., MBA PGY1 Community Pharmacy Resident Southwestern Oklahoma State University/Walgreen Co

Transcription

1 Brantley M. Underwood Pharm.D., MBA PGY1 Community Pharmacy Resident Southwestern Oklahoma State University/Walgreen Co

2 Describe the benefits of using a mobile application as a medication reminder tool for patients. All of the following are the benefits of using a mobile application as a medication reminder tool EXCEPT? A. Easy to update as medication regimens change B. Active participation by patients in their healthcare C. Alerts that can become annoying or a nuisance D. Potential improvements in patient s overall health

3 Walgreens Health System Pharmacy Located inside a Physician Medical Plaza Adjacent to St. Anthony Hospital in Oklahoma City No drive-through Small front-end merchandise Private consultation room Patient population Complex medications (HIV/AIDS, Hep C, oral oncology, transplant) Non-sterile compounding Medication adherence is a common and complex problem throughout the United States. Non-adherence costs $290 billion dollars per year. 1 Medication adherence in the United States scores as a C+ (79%) million patients are non-adherent. 2 No single intervention will fix everything. 64% of American adults have a smartphone. 3 Community pharmacists can promote mobile technologies to improve adherence.

4 Determine medication adherence rates utilizing the free Walgreens Mobile Application Pill Reminder Feature. Compare adherence rates from the study to national averages from the National Community Pharmacists Association (NCPA) or evidence-based clinical guidelines. NCPA report card 2 6 out of 10 patients admitted to missing a dose of medication in the past year. 3 out of 10 patients forgot if they had taken their medication already. 2 out of 10 patients took a lower dose of medication than prescribed. Chronic complex medications 20% of patients who have undergone a transplant are non-adherent. 4 36% of patients on long-term warfarin missed 20% of doses during a 32-week study. 5 95% adherence is recommended for HIV regimens to decrease the risk of virologic failure. 6

5 Study protocol was approved by Walgreens and SWOSU IRB committee. Patients incurred no expense to participate in the study. Patients were recruited via the following: Informational leaflets attached to prescriptions at neighboring Walgreens stores Upon picking up prescriptions filled at the pharmacy Through a computer-generated report Group 1 Group 2 or

6 Patients who met all inclusion criteria had a private consultation session with a pharmacist to: Set up the mobile application Input all medications Enable reminders Complete a basic demographic survey Answer any questions regarding the app or current medications Patients completing enrollment were compensated with a $10.00 Walgreens Loyalty Reward. Following initial meeting, patients were instructed to use the mobile application to log all medications taken, skipped (intentional), or missed (unintentional) during the four-month study period. Two months into the study, patients received/will receive a phone call to answer any questions. They were/will be instructed to /bring in their preliminary medication log. At the conclusion of the study, patients will meet with the pharmacist, /bring in their final medication log, complete a four-question follow-up survey, and receive an additional $10.00 Walgreens Loyalty Reward.

7 Demographic data collected Mobile application data collected Age Race/Ethnicity Education level Annual income Gender Technology comfort level Number of medications per day Consent for participation Willingness to pay for a medication adherence app Insurance status Taken doses of medication Time doses taken Skipped medication doses (intentional) Missed medication doses (unintentional) Number of pills taken for each dose Gets patients involved in their healthcare and medication management Potentially can increase medication adherence Provides alerts on a device which most patients have and use on a regular basis

8 18 patients have enrolled in the study. Data collection is on going. Participants were enrolled between 02/01 and 02/18. Mid-point data collection is occurring between 04/01 and 04/18. Final data collection will be between 05/31 and 06/17. Race/ Ethnicity Patient Demographics (n=18) Group 1 Patients (16)/Group 2 Patients (2) Black (5%) White (66%) American Indian (11%) Multiple races (18%) Insurance Status Medicare/Tricare (6%) Medicaid (6%) Priv. Insurance (66%) Dual Insurance (22%) Avg. Age 56 Years (45-80) Gender 28% Male/72% Female Education Level Technology Comfort Level Less High School (13%) HS/GED (13%) Some College Work (33%) College Degree or Higher (41%) Willing to pay for an adherence app? Yes (59%) No (41%) I usually avoid using new technologies. (6%) I generally take a while to use technologies. (33%) I use new technologies at the same time as most people. (44%) I usually use new technologies before anyone else. (17%)

9 Reviewed doses taken when scheduled (+/- 60 minutes) Reviewed doses taken outside of scheduled time Reviewed doses skipped Reviewed doses missed Small sample size Initial setup took on average of 45 minutes per patient. All HIV patients approached declined due to privacy. Windows phones and ipads were incompatible with the mobile application pill reminder feature. Although the counseling information is standardized, differences in pharmacists consultation techniques may lead to variations in the information presented to patients.

10 Nancy Williams, Pharm.D., BCPS, BCNSP, FASHP Henry Jay Kinnard, Jr., DPh Shanna Luber, DPh Walgreens pharmacy technicians at store SWOSU College of Pharmacy Resources Committee All of the following are the benefits of using a mobile application as a medication reminder tool EXCEPT? A. Easy to update as medication regimens change B. Active participation by patients in their healthcare C. Alerts that can become annoying or a nuisance D. Potential improvements in patient s overall health

11 1. Traynor, Kate. "Poor Medication Adherence Remains a Problem." Pharmacy News. AJHP News, 1 Nov Medication Adherence in America: A National Report Card (Rep.). (2013, June 25). Retrieved September 15, 2015, from National Community Pharmacy Association website: 3. Pew Research Center, April, 2015, The Smartphone Difference Available at: 4. Prendergast MB, Gaston RS. Optimizing Medication Adherence: An Ongoing Opportunity To Improve Outcomes After Kidney Transplantation. Clinical Journal of the American Society of Nephrology: CJASN. 2010;5(7): doi: /cjn Kimmel SE, Chen Z, Price M, et al. The Influence of Patient Adherence on Anticoagulation Control With Warfarin: Results From the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study. Arch Intern Med. 2007;167(3): doi: /archinte Adherence to Anti-HIV Therapy and the Outcome of Treatment. Ann Intern Med. 2000;133:21. doi: /

12 Brantley M. Underwood Pharm.D./MBA PGY1 Community Pharmacy Resident Southwestern Oklahoma State University/Walgreen Co