Beyond Refill Alignment: Evaluating the Impact of the Appointment-based Model on Medication Adherence
Creators: name: Cheng, Alice
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2021

description: Introduction: The appointment-based model (ABM) common language is a guide for community pharmacies to promote consistency in the implementation and operation of ABM medication synchronization (med sync). In chronological order, the five core components of ABM include the (1) identification and enrollment of patients, (2) medication review and patient assessment, (3) alignment of refills, (4) preparation of medications, and (5) delivery of medications in addition to other services. While alignment of refills forms the foundation of existing med sync programs and has been proven to improve pharmacy performance on medication adherence, it is uncertain if ABM core components beyond alignment of refills can positively impact medication adherence. Additionally, there currently exists great variability in how community pharmacies implement the ABM core components that expand beyond alignment of refills. Thus, the objectives of this project are as follows: 1) identify ABM core component(s) that significantly improve medication adherence and 2) evaluate the extent to which self-reported utilization of ABM impacts medication adherence.

Methods: A retrospective, cross-sectional analysis was conducted on 68 pharmacy members of a community pharmacy organization that responded to a previously adminstered self-assessment tool in November 2018. Medication adherence rates (proportion of patients at each pharmacy that achieved adherence (Proportion of Days Covered >0.80)) measured over a 6-month post-survey period were collected for each of the three chronic disease quality metrics: antihypertensive renin-angiotensin system antagonist (RASA) agents, antihyperlipidemic statins, and oral hypoglycemic agents. Linear regression analyses were then performed on each core component to determine the numerical impact and corresponding statistical significance of ABM operations on medication adherence.

Results: The following ABM operations used to implement the first four core components of ABM were associated with significant improvement in medication adherence across all chronic disease categories: patient recruitment, medication delivery, flexible payment options, documentation of synchronized medications and refill date, assessment of patient ability to fill medications prior to refill date, refill timelines, and inquiring about medication changes during the patient outreach call (p<0.05). Discussion of point of care testing was the only significant driver for adherence identified from ABM core component (5) (delivery of medications and other services) and did not appear to positively impact adherence. Synchronizing greater than 16% of a pharmacy’s total prescription volume was shown to significantly improve medication adherence, while synchronizing 31-50% produced significant
improvement in adherence across all chronic disease categories (p<0.05).

Conclusion: Implementation of ABM operations from the first four core components improves pharmacy performance on adherence. ABM utilization greatly improves medication adherence, and pharmacies wanting to improve adherence rates across every chronic disease category should strive to synchronize 31-50% of their medications.