Posted: 4/15/2019
Parkland medication adherence program improves care for patients with diabetes
An innovative pilot program called PSAM (Parkland Score for Adherence to Medication) is changing the way providers care for patients at Parkland Health & Hospital System’s clinics and facilitating population-based approaches to improve care for patients with chronic diseases such as diabetes. Thanks to a multi-disciplinary effort between the Global Diabetes Program, Parkland clinical providers, IT and clinical pharmacy staff, medication adherence data is now becoming available at the point of care so providers can know about challenges with medication refills and help find solutions.
Using algorithms and pharmacy data, Parkland developed PSAM to track patient adherence to taking their medication. In turn, that indicator of adherence is available in the electronic medical record for providers to access real-time while interacting with the patient during a healthcare visit.
“It’s important to know if patients are taking their medications as prescribed,” said Elizabeth Obialo, MD, lead physician at Parkland’s Garland Health Center, who typically sees more than 20 patients a day. At least half of them have been diagnosed with diabetes. In all, Parkland cares for more than 50,000 patients with diabetes.
PSAM is streamlining how she and other physicians know if their patients are getting the medicine they need and whether it’s working. A quick glance at the patient’s electronic health record gives the provider a “medication adherence score” based on prescription refill information, along with laboratory test scores, to instantly determine if further interventions are needed to ensure the patient’s well-being.
“If the PSAM score indicates the patient is taking their medication but their lab values are not where we want them, we can then adjust their medications as needed,” Dr. Obialo said. “If a patient’s medication adherence score is below 80%, I know there’s a problem and I immediately try to find out what is preventing the patient from picking up their prescribed medicines. Are they having trouble with transportation to get to a pharmacy? Can we put them on a mail refill program? Are they having side-effects or are they unclear about how often to take the drug? What are the barriers preventing them from taking the medicine?”
According to studies funded by the National Institutes of Health and the American Diabetes Association (ADA), medication non-adherence is one of the leading public health challenges facing the US. Researchers estimate that half of chronic disease medications are not taken as prescribed, an especially troubling statistic for physicians treating patients with type 2 diabetes. The ADA says that nearly 50% of patients with type 2 diabetes fail to achieve adequate glycemic control. One of the major contributing factors is poor medication adherence.
“There are many factors that could put patients at a high risk of non-adherence,” said Luigi Meneghini, MD, MBA, Executive Director of the Global Diabetes Program at Parkland and Professor of Internal Medicine at UT Southwestern Medical Center. “They can range from forgetfulness, poor eyesight or language barriers to low literacy levels, cultural gaps, transportation problems, fear of side-effects, financial concerns or missed appointments. As providers, it’s essential that we try to address these issues because the health consequences for diabetes patients who don’t control their glycemic levels can be very serious.”
“Medication adherence is not a new topic, but the way we’re bringing it to the point of care is,” explained Kristin Alvarez, PharmD, Associate Director of Pharmacy at Parkland. “Now, instead of asking ‘Are you taking your medication?’ the provider can have a pointed conversation such as, ‘I see that you may be having trouble filling your medications, can you tell me about that?” Alvarez said.
Data is reviewed in multiple ways, such as number of fills during a certain time period. The system can compare a patient’s “fill history,” meaning how often medication has been refilled, against how often it should have been refilled, which in turn helps show the patient’s persistence and adherence over time. The PSAM also accounts for hospital stays. Another approach is to look at gaps in therapy, for instance, if a patient continued with refills, but waited two weeks between each fill.
“Pharmacists have been doing this for years by essentially eyeballing gaps in patient fill history. Frontline providers aren’t used to analyzing that data and making the calculations while caring for the patient. But now we are automating those calculations and putting it in the providers’ hands at the time of care,” Alvarez said.
The impact could be far reaching because a medication adherence dashboard allows a population-based approach. These scores could help inform enterprise-wide decisions, identifying patient groups who are not taking their medications and the barriers to doing so, Alvarez explained. Data can be paired with demographic information such as ZIP code, financial class, marital status, gender, ethnicity and race, among others.
What’s more, increasingly healthcare organizations are held to performance measures by insurance companies and other funding sources, meaning patient adherence to medication can directly impact reimbursement, Alvarez added.
Still a pilot, the medication adherence data is being rolled out for various medication classes.
“In the end, we simply want to identify who’s having trouble with medication adherence and figure out why so that we can better help them with getting their disease under control,” said Dr. Meneghini.
For more information about services available at Parkland, visit www.parklandhospital.com.