Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

Objective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes. Design: Prospective, randomized control trial Setting: A local endocrinology group (clinic setting) and community pharmacies belonging to a regional integrated delivery network (IDN) in Toledo, OH Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy. Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB), Blister Pack (BP), Pill Bottle + Medication Therapy Management (PB+MTM), and Adherence Pharmacy (BP+MTM). Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed. Practice innovation: We partnered with a regional integrated delivery network (IDN) with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients. Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC) and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressures (DBP) were collected at baseline, 6 months, and 12 months Results: A mixed-model ANOVA was used to study the impact of these services on medication adherence, using PDC and pill count scores. Results of the 61 patients in the study revealed that there was a statistically significant difference between the PB and BP groups (p=0.008); between the PB and BP+MTM groups (p=0.023); and between the PB+MTM and the BP+MTM groups (p=0.041). Except at baseline