An Initiative to Improve Outcomes for Patients With Congestive Heart Failure
Cost is a major determining factor for patients deciding whether to pick up prescriptions from the pharmacy. When medications are too expensive, patients tend to abandon them regardless of how important they are to their health. In fact, studies have shown that patients are five times more likely to abandon a prescription that costs $50 versus one that costs $10.1 The impact of non-adherence is dire in terms of patient outcomes, with 125,000 avoidable deaths attributed to non-adherence every year.2
What if prescribers and patients could view prescription drug costs and discuss options at the point of care to avoid “sticker shock” at the pharmacy counter? Would patients who are prescribed more affordable medications be more adherent than patients who are prescribed more expensive medications? And could better adherence result in fewer avoidable Emergency Department visits and inpatient readmissions?
These are the questions that hospitalists, care navigators, and primary care providers at Magnolia Regional Health Center asked as part of an initiative to improve outcomes for congestive heart failure (CHF) patients. Physicians commonly prescribe antithrombotics or anticoagulants for this patient population to prevent cardiac events such as heart attack and stroke, which may result in hospitalizations and readmissions if patients do not adhere to their medication regimen.
A 3-Step Process to Understand Medication Adherence
The Magnolia Regional team rolled out a three-step approach to better understand the impact of having drug costs available to physicians and patients at the point of care.
Step 1: Establish a Baseline of Clinical Outcomes
Many studies have shown that lower medication adherence leads to much higher odds of CHF patients being readmitted to the hospital, and that interventions to improve medication adherence reduce readmission rates.
Step 2: Determine Which Medications Patients Were Not Filling Consistently
Next, it was important to determine the adherence levels of specific medications by patients who were readmitted versus those who were not readmitted.
Step 3: Implement New Technology Solutions
To test the impact of price transparency on how well patients adhere to their medication regimens, Magnolia Regional collaborated with DrFirst’s Applied Clinical Research team to gather and analyze medication history data.
Initial Study Results
From July 2020 to September 2021, Magnolia Regional and DrFirst studied medication adherence and prescription fill rates for 417 patients with CHF.
Click here to read the results.
Sources:
1. Pharmaceutical Research and Manufacturers of America, “69 percent of patients abandon medicines when cost sharing is more than $250,” Holly Campbell, August 23, 2018. https://catalyst.phrma.org/69-percent-of-patients-abandon-medicines-when-cost-sharing-is-more-than-250
2. New England Journal of Medicine, August 4, 2005
3. Medication adherence as a predictor of 30-day hospital readmissions, Rosen, et al, April 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404806/
4. Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates, Ruppar, et al, January 2022, https://www.ahajournals.org/doi/pdf/10.1161/JAHA.115.002606
5. Medication and Heart Failure, Riles, et al, January 2014, https://link.springer.com/article/10.1007%2Fs11886-013-0458-z
6. Anticoagulaton in Heart Failure: A Review, Zeitler and Eapen, June 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682916/
7. Cost-effectiveness and affordability of novel cardiovascular therapies: what physicians need to know, Ferro, et al, 2021, https://heart.bmj.com/content/107/15/1267
8. Pharmacologic Prophylaxis for Venous Thromboembolism and 30-Day Outcomes Among Older Patients Hospitalized With Heart Failure, Kociol, et al, November 2011, https://onlinelibrary.wiley.com/doi/full/10.1002/clc.20986