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Impact of a physician-led point of care medication delivery system on medication adherence.

OBJECTIVES
To evaluate the impact of a physician-led point of care medication delivery system (POCMDS) on adherence to glucose, blood pressure, and cholesterol-lowering medications.


STUDY DESIGN
Prepost intervention observational study.


METHODS
From December 15, 2010, to December 14, 2012, we conducted a prepost analyses of 800 Medicare Advantage members receiving care in a network of capitated clinics in south Florida serving a predominantly minority population. Eligibility criteria included a diagnosis of diabetes for at least 1 year, taking at least 1 of the 3 classes of medications, and having received care in the clinic network for at least for 12 months before and after the POCMDS implementation. Our primary outcome is the medication possession ratio (proportion of days covered [PDC]) for each class of medication.


RESULTS
We found an absolute increase of 17 percentage points (95% CI, 13-20) in the PDC for oral antidiabetic agents, 29 (95% CI, 26-32) for cholesterol medications, and 21 (95% CI, 19-23) for blood pressure medications. Most of the subjects (80%) reported POCMDS was more convenient than using retail pharmacies. By having the POCMDS prioritize generic medications, the increases in adherence were not associated with increased pharmacy costs. At baseline, over half the patients were at goal for low-density lipoprotein cholesterol, glycated hemoglobin, and systolic blood pressure; thus, we did not detect any additional improvements in these intermediate clinical outcomes.


CONCLUSIONS
Among elderly minority patients with diabetes, a POCMDS improved adherence to various medications classes without increasing pharmacy costs. Thus, POCMDS may be of interest to policy makers, particularly in our current era of healthcare reform.