November 10, 2014
Patients receiving free or low-cost medications may not follow their prescriptions perfectly, but they’re not much different than patients who have insurance, according to a study from the University of North Carolina at Chapel Hill.
Morris Weinberger, PhD, Vergil N. Slee Distinguished Professor of Healthcare Quality Management in the Gillings School of Global Public Health’s Department of Health Policy and Management and senior research career scientist at the Durham VA Medical Center for Health Services Research, is among the study’s co-authors.
The researchers studied patients enrolled in the UNC Health Care Pharmacy Assistance Program (PAP) from 2009 through 2011 who received medication for high blood pressure, diabetes or high cholesterol. The program provides free or reduced-cost medication to low-income patients.
“Low-income patients who have chronic diseases but not insurance have a difficult time getting medications reliably, which often leads to serious, unnecessary, and costly health problems,” said lead author Drew Roberts, PharmD, a postdoctoral fellow in health services research at the Cecil G. Sheps Center and doctoral candidate at the UNC Eshelman School of Pharmacy.
“We demonstrated that when uninsured North Carolinians are given access to medicines for chronic diseases through the PAP, they will take those medicines about as well as patients with insurance do.”
The study set the bar for optimal adherence at 80 percent, meaning patients took their medications as directed by their health-care providers 80 percent of the time. Their medication use was monitored over a period of six months.
About half of study participants who were taking medications for the three chronic conditions hit the 80-percent adherent mark. Rates of adherence seen in this study are comparable to those seen in studies of patients with prescription insurance, Roberts said.
The percentages of PAP patients who adhered to their prescription medication regimen 80 percent of the time were:
- 38 percent of those taking medication for high cholesterol (compared with 40 to 50 percent of patients with insurance);
- 52 percent of those taking medication for high blood pressure (compared with 36 to 56 percent of patients with insurance); and
- 45 percent of those taking medication for diabetes (compared with 55 percent of patients with insurance)
In North Carolina, about 9 percent of adults have diabetes, 31 percent have high blood pressure, and about 34 percent have high cholesterol, according to the Centers for Disease Control and Prevention. The diseases selected for the study are some of the most costly conditions in the United States.
The study, published in the North Carolina Medical Journal, also found that PAP patients who took their medications as prescribed were more likely to be older, more likely to be white, and more likely to be taking multiple prescriptions.
Faculty members from the UNC Eshelman School of Pharmacy, the UNC School of Medicine, and the UNC Gillings School of Global Public Health collaborated on the study, along with clinicians at UNC Health Care.
Studies show that improved medication adherence is associated with fewer hospitalizations and fewer emergency room visits, Roberts said.
Ginny Crisp, PharmD, pharmacist at UNC Hospitals, assistant professor at the pharmacy school, and one of the study’s coauthors, said the study will guide the operation of UNC’s assistance program and also be valuable to other similar programs.
“This study provides valuable evidence for administrators of similar charitable pharmacy assistance programs in other states serving large numbers of uninsured patients, primarily states that have opted out of expanding Medicaid eligibility under health reform,” Crisp said. “We have also identified clear opportunities to improve the pharmacy care here at UNC by increasing medication adherence of PAP participants and improving the care they receive.”
As a result of the study, UNC Health Care is implementing the Carolina Assessment of Medications Program (CAMP), Crisp said. CAMP is a pharmacist-led clinic that provides personalized medication therapy management to patients with a focus on improving their medication adherence and health while at the same lowering costs for the health system.
From 2009 through 2011, the PAP at UNC Health Care served 7,180 patients from eighty-one counties in North Carolina. PAP users received an average of twenty-three prescriptions at an average cost of $754 per recipient per year. UNC Health Care spent an average of $2.93 million per year on the program. Inpatient care and emergency department care were used by approximately 30 percent of PAP participants.
In addition to Roberts and Weinberger, study authors include Denise Esserman, PhD, formerly research assistant professor of biostatistics at the Gillings School and of medicine in the UNC School of Medicine, and from the Eshelman School, Joel Farley, PhD, associate professor in the Division of Pharmaceutical Outcomes and Policy.
The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Award Number 1UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.