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Trends in Pharmacy Benefits Management

Submitted by CVS Caremark, March 2011

New Study Finds Pharmacists and Nurses are the Most Effective Health Care ‘Voices’ in Promoting Medication Adherence

A new study looking at in-person, electronic, telephonic, fax and mail communications that counsel patients to stay on their medications concludes that pharmacists at a retail store are the most influential health care "voice" in getting patients to take medicine as prescribed.

The research, based on a review of more than 40 years of studies published in medical journals, showed that nurses talking with patients as they are discharged from a hospital are the second most influential voice encouraging patients to stay on their medicines. Both in-store pharmacists and hospital-based nurses are more effective than pharmacists communicating to a patient via the telephone or doctors instructing patients regarding prescriptions, the researchers said.

These findings are contained in two separate reviews of medical journal studies sponsored by CVS Caremark and carried out by a team of researchers from Harvard University, Brigham and Women’s Hospital and CVS Caremark. In December, the American Journal of Managed Care (AJMC) published a review that focused on communications between pharmacists and nurses with their patients. The AJMC study builds upon a review by the same researchers that focused on doctor and patient communications and was published last May in the Journal of General Internal Medicine.

"There have been many studies on the subject of boosting adherence. We decided it was important to review the total body of work to determine which communication channel had the greatest impact," said William Shrank, MD, MSHS, of Brigham and Women’s Hospital and Harvard, and a lead author of the studies. Shrank said the researchers combed through more than 6,500 medical journal articles published between 1966 and December 31, 2008, before reviewing 168 articles in full.

The study found that programs using mail, fax and brochure-type (non-personal) communications had relatively low impact on promoting patient adherence. A review of the use of electronic communications, such as videos and interactive technology, show promise but were determined to have medium impact on increasing adherence among patients.

The highest impact programs featured work by pharmacists talking to patients in a store, followed by nurses talking face-to-face with patients who were leaving a hospital, the researchers concluded. Face-to-face discussions between pharmacists and patients in a store were twice as effective in boosting adherence rates as programs where pharmacists talk with patients on the telephone, the researchers found.

"These findings offer payers, health care providers and policy makers guidance about how to develop programs that improve patient adherence," said Troyen A. Brennan, MD, MPH, executive vice president and chief medical officer of CVS Caremark, and an author of both reviews. "We know that pharmacists and nurses are among the most trusted health care professionals. This study shows that trust translates into effective patient communications."

Improving adherence is important because by keeping patients on prescriptions as directed their health status is stabilized. Further, medication adherence is a cost-effective way to avoid unnecessary doctors’ visits or hospitalizations. Non-adherence to medications costs the health care system up to $290 billion a year because many of the hospitalizations can be avoided if people take prescriptions as doctors direct.

The study is a product of CVS Caremark’s previously announced three-year collaboration with Harvard University and Brigham and Women’s Hospital to research pharmacy claims data to better understand patient behavior, particularly around medication adherence.

Topics: Pharmacy Benefits Management (PBM)