title: Impact of Appointment-Based Medication Synchronization on Existing Users of Chronic Medications.
abstract: BACKGROUND
  Appointment-based medication synchronization (ABMS) has been associated with greater patient adherence and persistence when patients begin taking chronic medications. It is not known whether similar results will be seen for patients who have been taking chronic medications for 6 months or more.
  
  
  OBJECTIVE
  To compare the impact of a community pharmacy chain's ABMS program on medication adherence and persistence of existing users of chronic medications with individuals who are not enrolled in the program.
  
  
  METHODS
  A retrospective cohort study compared patients receiving ABMS with matched comparison groups receiving usual care. ABMS consisted of synchronizing a patient's medications to be dispensed on a single appointment day every month, a call to the patient prior to the appointment day to address any prescription changes and to remind the patient, and a patient visit to the pharmacy to pick up the medications. Outcomes were 1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. Data for this study came from prescription claims records of patients taking 1 of 6 chronic medication classes during the period of December 1, 2011, to February 28, 2014. ABMS patients were matched with comparison groups according to prior adherence behavior, medication class, age, gender, and geographic region.
  
  
  RESULTS
  Mean PDC scores ranged from 0.73 to 0.91 for ABMS patients (n = 205 to 716) and from 0.57 to 0.71 for usual care depending on the medication class. The percentage of adherent individuals (i.e., PDC ≥ 0.80) was 55% to 84% for ABMS participants and 37% to 62% for usual care. Odds of adherence was 2.3 to 3.6 times greater with ABMS. Usual care patients became nonpersistent (61% to 74%) more often than ABMS patients (33% to 44%) with hazard ratios of nonpersistence being 0.39 to 0.67 for individuals in the program.
  
  
  CONCLUSIONS
  An ABMS program in a community pharmacy setting was associated with higher rates of adherence and persistence for patients who had been taking chronic medications for at least 6 months. Approximately 18 to 35 additional ABMS participants were adherent for every 100 patients enrolled when compared with usual care. For every 100 patients receiving usual care, 17 to 40 additional patients in the ABMS group were persistent. This study shows that ABMS programs can improve medication adherence and persistence for patients who are newly prescribed or currently taking chronic medications.
authors.affiliation: Virginia Commonwealth University School of Pharmacy, McGuire Hall, Rm. 213, P.O. Box 980533, 1112 E. Clay St., Richmond, VA 23298-0533. daholdfo@vcu.edu.
authors.forename: David
authors.initials: D
authors.lastname: Holdford
authors.forename: Kunal
authors.initials: K
authors.lastname: Saxena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D002908:Chronic Disease / Q000188:drug therapy*; D003157:Community Pharmacy Services; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors