RESUMO
BACKGROUND: Primary medication nonadherence (PMN) occurs when a new medication is prescribed, but the patient does not obtain the medication, or an appropriate alternative. Medication knowledge may be a factor contributing to high PMN rates. A variety of approaches and technologies have been developed to enhance patient medication knowledge, though the impact of these interventions on PMN rates has not been studied. OBJECTIVES: The objectives of this study were to: 1) compare community pharmacy PMN rates between pharmacies that offer patient medication educational video services and those that do not, and 2) assess the relationships between video service delivery and PMN status. METHODS: This cohort study utilized data from six pharmacies (three case, three control). Adult individuals with a new electronic prescription for medications were assessed for PMN using the Pharmacy Quality Alliance (PQA) measure specifications. A 6-month measurement period was used to assess if medications or an appropriate alternative were dispensed within 30 days. Descriptive statistics were used to evaluate differences in PMN rates between case and control pharmacies. The relationships between medication education video service use and PMN status were assessed using multivariable logistic regression models. RESULTS: A total of 4038 patients were included in the analyses, contributing 6311 prescriptions for PMN assessment. Case pharmacies had significantly lower (25.9% versus 29.1%) PMN rates than control pharmacies (p=0.0090). Prescriptions filled at pharmacies that utilized medication educational videos had lower odds of PMN status [OR = 0.58 (0.43, 0.78)] than controls. Video use was associated with lower odds of PMN status [OR = 0.83 (0.70, 0.98)] when compared to prescriptions where patients did not receive the service. CONCLUSIONS: The use of health literacy-conscious, patient educational videos were associated with improved (lower) PMN rates. Medication education technologies represent a scalable solution to improve PMN and medication access.
RESUMO
OBJECTIVE: The SUPPORT Act provided resources for developing prescription drug monitoring programs (PDMPs) capable of reporting on four specific opioid quality measures. Therefore, the objective of this pilot study was to map, test, and adapt these claims-based opioid quality measures specified for health plan performance to PDMP data for state-level performance. MATERIALS AND METHODS: Maryland PDMP and claims from Maryland Medicaid beneficiaries continuously enrolled from April 1, 2019, to March 31, 2020. RESULTS: The measure rates as specified using claims data are closely aligned with the measure rates when mapped and adapted to PDMP data. The Concurrent Use of Opioids and Benzodiazepines measure rates were 14.49% and 15.31%, the OHD rates were 12.44% and 13.54%, the OHDMP rates were 0.01% and 0.40%, and the Use of Opioids from Multiple Providers in Persons Without Cancer rates were 0.12% and 3.03% for the claims-based and adapted measures, respectively. DISCUSSION: This is a novel application that may be replicated in other states to support quality improvement and can have a measurable effect on stemming the drug abuse epidemic. CONCLUSIONS: This will facilitate data sharing of the opioid quality measure reporting within the Maryland PDMP and stakeholders responsible for caring for Maryland Medicaid beneficiaries. Owing to the encouragement by the Centers for Medicare and Medicaid Services, other states' PDMPs may require the adaptation of these measures. This will open the door for innovative state-level policy and practice interventions. The quantification of outcomes related to these measures will inform our learning healthcare system and help support the Quintuple Aim.