An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care.

The adherence impact of a program offering specialty pharmacy services to patients using retail pharmacies.

BACKGROUND: A new service model integrates the specialty pharmacy's comprehensive service with the retail pharmacy's patient contact, giving patients options for medication delivery to home, pharmacy, or doctor's office. OBJECTIVE: Evaluate the impact of the new service model on medication adherence. DESIGN: Retrospective cohort study SETTINGS: One hundred fifteen CVS retail stores in Philadelphia participated in a pilot from May 2012 to October 2013, and 115 matched CVS retail stores from around the nation served as controls. PATIENTS: All eligible patients from the intervention and control stores received specialty medications through CVS retail pharmacies prior to implementation of the new service model. INTERVENTION: The intervention patients were transitioned from retail pharmacy service to the specialty pharmacy with delivery options. The control patients received standard retail pharmacy services. MAIN OUTCOME MEASURES: Proportion of days covered and first fill persistence were tracked for 12 months before and after program implementation. RESULTS: Under the new service model, 228 patients new to therapy in the post period had a 17.5% increase in the rate of obtaining a second fill as compared to matched controls. Patients on therapy in both the pre- and the post-periods had a pre-post increase of 6.6% in average adherence rates and a pre-post increase of 10.8% in optimal adherence rates as compared to 326 matched controls. CONCLUSION: The study demonstrated significant improvement in both adherence to therapy and first-fill persistence among patients in the new service model integrating specialty pharmacy's comprehensive services with the retail pharmacy's patient contact and medication delivery choices.

Impact of CYP2C19 genetic testing on provider prescribing patterns for antiplatelet therapy after acute coronary syndromes and percutaneous coronary intervention.

BACKGROUND: Patients treated with clopidogrel who have ≥1 loss of function alleles for CYP2C19 have an increased risk for adverse cardiovascular events. In 2010, the US Food and Drug Administration issued a boxed warning cautioning against the use of clopidogrel in such patients. We sought to assess the impact of CYP2C19 genetic testing on prescribing patterns for antiplatelet therapy among patients with acute coronary syndrome or percutaneous coronary intervention. METHODS AND RESULTS: Patients with recent acute coronary syndrome or percutaneous coronary intervention prescribed clopidogrel were offered CYP2C19 testing. Genotype and phenotype results were provided to patients and their physicians, but no specific treatment recommendations were suggested. Patients were categorized based on their genotype (carriers versus noncarriers) and phenotype (extensive, intermediate, and poor metabolizers). The primary outcome was intensification in antiplatelet therapy defined as either dose escalation of clopidogrel or replacement of clopidogrel with prasugrel. Between July 2010 and April 2012, 6032 patients were identified, and 499 (8.3%) underwent CYP2C19 genotyping, of whom 146 (30%) were found to have ≥1 reduced function allele, including 15 (3%) with 2 reduced function alleles. Although reduced function allele carriers were significantly more likely than noncarriers to have an intensification of their antiplatelet therapy, only 20% of poor metabolizers of clopidogrel had their antiplatelet therapy intensified. CONCLUSIONS: Providers were significantly more likely to intensify antiplatelet therapy in CYP2C19 allele carriers, but only 20% of poor metabolizers of clopidogrel had an escalation in the dose of clopidogrel or were switched to prasugrel. These prescribing patterns likely reflect the unclear impact and evolving evidence for clopidogrel pharmacogenomics.

Evaluation of a school-based HIV/AIDS educational intervention in Ukraine.

PURPOSE: To assess changes observed in knowledge, attitudes toward people living with human immunodeficiency virus (HIV), self-efficacy and behavioral intentions of senior secondary school students after an HIV/AIDS (acquired immune deficiency syndrome) educational intervention in Vinnitsa, Ukraine. METHODS: A quasi-experimental, nonequivalent control group design with pretest-posttest components was employed. Two secondary schools (intervention and control) were randomly assigned to the study. A random sample of the 15-16-year-old students (100 participants in each school) completed anonymous self-reported pre- and postintervention questionnaires. In addition, a three-month follow-up questionnaire was administrated in both schools to assess the longevity of the intervention outcomes. Outcome scale scores were compared between the two groups on baseline, first, and second posttests separately. We used the Pearson chi-square test for categorical data and a t-test for difference in mean scores. RESULTS: After intervention we observed significantly higher knowledge, attitudes, and self-efficacy scores among students in the intervention school than in the control school (96.2 +/- 6.2 [SD] vs. 82.6 +/- 8.3, respectively, p < .01; 24.4 +/- 4.4 vs. 21.7 +/- 4.8, respectively, p < .01; 21.9 +/- 2.6 vs. 20 +/- 3.8, respectively, p < .01). As a result of the intervention, we also report significantly higher proportions of students in the intervention school than in the control school who would not intend to use alcohol and narcotics and who intend to use condoms (p < .01). CONCLUSIONS: Our AIDS education program was able to considerably improve students' knowledge, attitudes and self-efficacy, and promoted positive changes in participants' behavior intentions; it should therefore be extended to more schools to multiply its effects. However, in the context of evaluation, studies with actual HIV-risk behavior outcomes are urgent for Ukraine.