Major Finding: At 12 months, the likelihood of an oral medication adherence rate above 80% was 4.77 times greater among the intervention group than among controls, a significant difference despite wide confidence intervals.

Data Source: A randomized controlled study of 265 patients with type 2 diabetes conducted with pharmacists at four Safeway pharmacies in Washington state.

Disclosures: The study was funded by a grant from the American Association of Diabetes Educators' Education and Research Foundation.

SAN ANTONIO — A personalized phone call from a retail chain store pharmacist to patients who missed diabetes prescription refills significantly improved medication adherence at 1 year in a study of 265 patients with type 2 diabetes.

“Because adults with diabetes visit pharmacies more often than they visit any other health professional [setting], it is believed there is an untapped opportunity for pharmacists to provide self-management education and support for medications,” said certified diabetes educator Peggy S. Odegard, Pharm.D.

The randomized, controlled Medication Adherence Program (MAP) study was conducted at four pharmacies inside Safeway grocery stores in Washington state. When a prescription refill for an oral glucose-lowering medication was missed by 6 days, a pharmacist would call the patients to ask why they had missed the refill and whether they would like to refill it now. Depending on the response, the pharmacist would offer individualized advice and education.

A follow-up phone call was made at 1 week to 1 month after the intervention to further assess the patients' needs and address any problems.

The subjects had all been using the pharmacy consistently for a year or longer.

The 145 controls, who were not called when refills were missed, were slightly younger, with a mean age of 61 years, compared with 65 years for the 120 who received the phone call intervention. The groups' other baseline characteristics were similar, including sex (a little more than half were women), the number of different medications they were taking, and the proportion who were on insulin (23% in both groups).

Among 119 patients who reported problems with taking their medications, 27% cited “difficulty with taking medication,” 26% said they simply “forgot to order refills,” and 8% “forgot to pick up refills.” Of those with “difficulty taking medication,” the most common difficulty listed was “remembering dose.”

Adherence was assessed by the change in “medication possession ratio” (MPR),” or the number of days of medication supplied in a prescription fill divided by the number of days until the prescription was refilled. For example, a 30-day supply that is filled and then refilled in 30 days would yield an MPR of 1.0. But if a patient receives a 30-day prescription but doesn't refill it for 60 days, the MPR would be 0.5, or half the adherence rate expected, explained Dr. Odegard, of the University of Washington, Seattle, in an interview.

At baseline, MPR for diabetes medications did not differ between the two groups (0.86 for the intervention group and 0.84 for controls). However, the proportion of patients with an MPR greater than 0.8 was slightly higher in the intervention group than in the controls (74.4% vs. 65.2%), meaning that it would be harder to prove that the intervention worked because the patients in that group already were somewhat more adherent, Dr. Odegard pointed out.

Over 12 months, the pharmacists conducted an average of 3.4 phone call interventions (or occasionally in-person interventions) per patient, and were reimbursed $10 per intervention. Interventions lasted an average of 12.6 minutes each. In addition to diabetes education (including advice on prevention of medication side effects) and adherence support (including integration of medication dosing with daily activities), pharmacists helped to optimize the patients' regimen with the prescriber and/or helped with economic adjustment (for example, a change to generic).

At 12 months, the MPR was significantly improved in the intervention group (up to 0.90 from 0.86), whereas in the control group the MPR declined slightly (from 0.84 to 0.82). The difference in MPR between the two groups at 12 months also was significant. Moreover, the likelihood of an oral medication adherence rate greater than 80% (MPR 0.80 or higher) was 4.77 times greater among the intervention group than in the controls. This difference was significant despite wide confidence intervals, said Dr. Odegard.

Dr. Odegard and her associates are hoping to integrate this type of program into local pharmacy chains. Several remaining challenges include the fact that patients don't always pick up their own medications, some might use both community and mail order pharmacies, and some might have multiple physicians for their diabetes care.

During the question-and-answer period, Dr. Odegard remarked that such programs could provide a significant revenue stream to pharmacies. She and her colleagues are currently conducting a cost analysis.

Pharmacist Phone Calls Improved Diabetes Rx Adherence