Getting in sync: Improving adherence through medication synchronizationMarch 14, 2016
Recently there’s been more talk about a new approach to help people with chronic conditions become more adherent to their medications: medication synchronization. Sounds complicated, but it simply means that someone taking a number of different medications for chronic conditions gets all their prescriptions refilled at the same time.
Plan members with chronic conditions don’t stick2it
As we at GSC have learned over and over again, plan members with chronic conditions aren’t very good at sticking to their drug regimes. Many people are non-adherent from the moment they receive their prescription. For example, 88 per cent will have a prescription filled, but only 76 per cent will actually take the medication, and only 47 per cent will continue to take it.1
More medications = less adherence
Evidence shows that the more medications a person is taking, the less adherent they are.2 This is in part because they have to keep track of their refills and make multiple visits to the pharmacy for those refills. That’s why people taking multiple medications for chronic conditions benefit from medication synchronization.
Here’s how medication synchronization works (it’s not complicated)
Plan members taking multiple chronic medications typically refill each of those medications on a different cycle – making multiple trips to the pharmacy. For example, they may refill one medication on the first of the month, but refill a second medication on the 12th, then refill a third the week after that. That’s three trips to the pharmacy during each fill cycle.
By working with their pharmacist, that plan member can arrange to pick up all three refills on the same day each fill cycle. The process, which involves “short fills,” to synchronize the medication can be challenging in the early stages as it may take a few refills of smaller quantities to get all the drugs aligned on the same refill date or “sync date.”
From the sync date forward, the patient is scheduled to pick up all of their refills on the same day each fill cycle. The addition of new drugs to the regimen or other changes, such as an unexpected hospitalization, could de-sync the patient, which would then require re-synchronization. In many ways, synchronization is a continuous effort that must be monitored and maintained but one that has substantially positive implications for patients.
Medication synchronization: the details…
As an example, let’s look at how medication synchronization was set up for a U.S. study. The first step was to inform pharmacy patients about the program, and those interested were scheduled for a synchronization appointment with their pharmacist.
At the synchronization meeting:
- The applicable medications were discussed to assess the patient’s current therapy and determine whether any changes should be made. For example, whether compliance packaging was indicated.
- A future date – the sync date – was agreed to by the patient and the pharmacist.
- Medications that required short fills were identified so that they would all sync on the chosen date.
- The quantity (e.g., 30 days’ or 90 days’ supply) that would be dispensed once all the drugs were synchronized was established. The supply depended on the patient’s desire and/or third-party requirements.
- A cost estimate was prepared and payment timing and method were arranged.
- Patients were given the opportunity to ask questions about their medications and the synchronization process.
- Patients then signed an agreement form.
After the meeting:
- Based on the sync date chosen and the number of pills the patient had remaining for each drug, the pharmacist calculated and dispensed the short fills.
- The patient or pharmacist notified the physician that the patient was enrolled in a medication synchronization program.
- A centralized refill centre filled the prescriptions about a week before the sync date, and any issues relating to the medication or benefits coverage were resolved before the drugs were delivered to the patient’s retail pharmacy location.
- Three days before the sync date patients received a reminder call and pharmacists followed up with anyone who was late in picking up their drugs.
- Changes to prescriptions or patient questions were addressed by a central patient care centre before the patient’s next refill date.
- Patients met monthly with their pharmacist which allowed for additional medication management and support depending on the patient’s needs.3
It’s a win-win-win
The long-term convenience of medication synchronization is popular with patients and leads to increased adherence to drugs for chronic conditions – positively impacting health outcomes. Evidence shows that patients who have synced their chronic medications are about 30 per cent more adherent than patients who are not in a medication synchronization program.4
From a pharmacy perspective, medication synchronization allows more predictability in prescription volume, and provides pharmacists with a consistent interaction with the patient. It also allows pharmacists to be proactive by:
- arranging appointments with patients
- having the drugs ready for pickup
- calling patients with reminders about the appointment
- combining the patients’ scheduled visit with other services, such as the Pharmacist Health Coaching – Cardiovascular or Smoking Cessation Program
Not only is medication synchronization beneficial for plan members and pharmacists, but it’s also good for benefits plans. Adherent plan members stick to their chronic condition drug regimens – and evidence indicates that adherence is directly related to health outcomes. More adherent plan members are less likely to see their conditions deteriorate and suffer downstream health care consequences and associated costs.5
Now in Canada
While medication synchronization is a well-established practice in the United States, it has only very recently started to catch on in Canada. Part of the reason for the faster adoption in the U.S. has to do with the quality improvement targets built by payers such as Medicare. Many of those targets are tied to plan member adherence. Therefore, pharmacies have looked to medication synchronization as a tool to help improve adherence and subsequently improve their quality ratings. The evidence for the benefits of medication synchronization coming out of the U.S. is now convincing Canadian pharmacies of its value.
Who’s on the bandwagon…
Rexall started providing medication synchronization services early in 2016 in their pharmacies across Canada. The services are available free of charge to any patient taking multiple chronic medications.
While Rexall is first off the mark, we expect to see other pharmacies jump on board in the coming months and years making medication synchronization a standard service.
1“Medication Adherence: Its Importance in Cardiovascular Outcomes,” P. Michael Ho, Chris L. Bryson, and John S. Rumsfeld, Circulation: American Heart Association, 2009. Retrieved: March 2016. http://circ.ahajournals.org/content/119/23/3028.full
2-4“Adherence and persistence associated with an appointment-based medication synchronization program,” David Holdford and Timothy Inocencio, Journal of the American Pharmacists Association, Nov/Dec 2013. Retrieved: March 2016. http://www.japha.org/article/S1544-3191(15)30403-9/fulltext
5“Pharmacists increase patient adherence to drug therapy, improving health outcomes and lowering health care costs,” The Translator: Canadian Pharmacists Association, Winter 2012. Retrieved March 2016. http://www.pharmacists.ca/cpha-ca/assets/File/education-practice-resources/Translator2012V6-1EN.pdf