Trends in Adherence and Patient Outcomes in a Safety Net Medication Therapy Management Program

OBJECTIVES: The study objectives are to (1) evaluate the impact of expanding access to care on, and (2) examine the trends between, medication adherence and other patient outcomes for a safety net patient population participating in an urban Medication Therapy Management program. METHODS: Patients with diabetes, hypertension, and/or hyperlipidemia were enrolled in a pharmacist led MTM program through CareNet, a Toledo, OH safety net organization. This one year prospective pre-post funded study provided patients with access to health care providers, educational material, coveredprescription drugs and testing supplies for the study period. Clinical and humanistic outcomes were measured at staggered intervals and analyzed to evaluate the impact of MTM care. The Morisky scale was used to measure patients' adherence to medications. The change in adherence was correlated with treatment outcomes to determine the significance of adherence in safety net patients. RESULTS: A significant decrease was reported in diastolic blood pressure (p < .016) and in systolic and diastolic blood pressure in patients with BP > 140/90 mmHg (p < .038, .043, respectively) as well as in hypoglycemic events (p < .018) at 12 months. There was also a significant increase in patient satisfaction for the pharmacist (p < .017) over the course of enrollment. Of the 72 diabetic patients enrolled at baseline, only 16 remained in the program at the end of the one-year time period. Thirty-four patients had substantial data to analyze the impact of adherence on treatment outcomes. The average baseline adherence per patience was 1.88 and improved by 0.118 on the Morisky scale (1 = good and 5 = poor). There were no significant correlations between collective adherence and the other outcome measures. However, patients who reported improved adherence were significantly correlated to a decreasing systolic blood pressure (p < .003), while patients showing no improvement were significantly correlated to an improvement in self-monitoring of blood glucose (p < .001). CONCLUSIONS: In MTM, patients show improvement in many patient care outcomes including medication adherence. Pharmacists can use these trends in adherence to optimize outcomes in safety net patients. Further adherence research is needed and it is recommended using a larger sample, longer study duration, expanding to other disease states and using other techniques to measure medication adherence.