A Texas med-adherence program tailored to the cultural and linguistic needs of seniors brought pharmacists to patients in community-based residential facilities.
Recently, Texas was the site of a successful pharmacy-led medication therapy management (MTML) program for senior patients with diabetes and hypertension. Conducted in 2013, the MyRx Medication Adherence Program offered home-based medication management and health education tailored culturally and linguistically to seniors with hypertension and/or diabetes living in community-based residential facilities.
The program was led by Texas Southern University (TSU) College of Pharmacy and Health Sciences in Houston. Funding was obtained through the Office of Minority Health, which contracted with Westat, Inc.
Aisha Morris Moultry“As trusted healthcare professionals with expertise in medication therapy, pharmacists were ideal to provide MTM services to diabetic elderly patients in their homes. This population often presents with multiple chronic disease states, multiple medications, and limited mobility, creating an environment for potential reduced medication adherence and thus an opportunity for pharmacist involvement,” said Aisha Morris Moultry, PharmD, associate professor of pharmacy practice and associate dean of Clinical and Administrative Services for Texas Southern University College of Pharmacy and Health Sciences.
Through the Houston Housing Authority, Morris Moultry identified patients who needed the program. Then pharmacists visited participants in their homes to perform a medication assessment and reconciliation, offer personalized education, and develop a care plan.
After the visits were completed, health educators from partner Harris Health System hosted two group sessions at the residential facilities - one focused on healthy eating and one on physical activity and stress management. After each session, pharmacists called patients to follow up on the care plan and answer questions.
With a budget of $280,000 for the program, which lasted four months, 13 community pharmacists were contracted to work varying hours. Eight pharmacy students from TSU also assisted with data collection and entry. The costs of running MyRx included payments to pharmacists and the student translator, the cost of materials, incentive payments to participants ($15 each), and research-related expenses.
Despite the cost, the results were positive. Patients experienced modest reductions in systolic blood pressure (from 139.8 to 137 mm Hg) and diastolic blood pressure (from 77.3 to 77.1 mm Hg). Medication adherence scores improved from 190.2 to 195.9 for hypertension and from 191.2 to 196.11 for diabetes (out of a total of 200 possible points).
However, progress on patients’ blood glucose levels was inconclusive. “We really wanted to administer the program for a longer period of time, to be able to demonstrate a greater clinical impact. However, due to circumstances beyond our control, connected with the funding agency, we were unable to extend the program,” Morris Moultry said.
Still, focus groups held with participants at the end of the program revealed that patients were “extremely satisfied with the program and changed their health behaviors based on knowledge gained from the program,” Morris Moultry said.
In addition, the participating pharmacists were enthusiastic about engaging directly with patients in their homes, she said.
“This gave them an opportunity to identify factors in the patients' living environments that may have had an impact on their care,” she said.
The pharmacists also valued the training in motivational interviewing they received as part of the process of preparing for the program.
“They appreciated the professional development and found it useful in their everyday practice,” Morris Moultry said.
Other pharmacists can implement a similar program by seeking funding through federal and local agencies, she suggested.
Another useful move is to form a work group to provide input on the program during development, as these researchers did. Their group included representatives from the local chapter of the American Diabetes Association, the local African-American Health Coalition, and MD Anderson Cancer Center.
The greatest challenge in this type of home-based medication adherence program is getting buy-in from health systems, said Morris Moultry.
“It is important to adequately demonstrate the value of having an MTM program within an organization. This starts with having an understanding of the indicators of success for an organization, whether it is from the perspective of the patient, the provider, or the institution, and then demonstrating how this type of program will help improve them,” she said.