title: Evaluation of specialized medication packaging combined with medication therapy management: adherence, outcomes, and costs among Medicaid patients.
abstract: BACKGROUND
  This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients.
  
  
  METHODS
  A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization.
  
  
  RESULTS
  Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54-1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI,1.65-1.89; 12-month cost ratio = 1.84, 95% CI,1.72-1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups.
  
  
  CONCLUSIONS
  : The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.
authors.affiliation: Center for Implementing Evidence-Based Practices, Roudebush VA Medical Center, Indianapolis 46202-2879, USA. azillich@purdue.edu
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zillich
authors.forename: Heather A W
authors.initials: HA
authors.lastname: Jaynes
authors.forename: Margie E
authors.initials: ME
authors.lastname: Snyder
authors.forename: Jeff
authors.initials: J
authors.lastname: Harrison
authors.forename: Karen Suchanek
authors.initials: KS
authors.lastname: Hudmon
authors.forename: Carl
authors.initials: C
authors.lastname: de Moor
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004349:Drug Packaging / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D012189:Retrospective Studies; D013689:Telephone; D014481:United States; D016903:Drug Monitoring