Bechtol, R.A.

Conner, T.

Omerza, K.

Pinto, S.L.

Elsevier - Publisher Connector 

 VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 1 - A 2 9 5  A139
PHS84
FactorS aFFecting acceSS and adHerence to tHe recommended LeveL 
oF diabeteS care in tyPe ii diabeteS aduLtS
Gala S.D., Wu W.K.
St. John’s University, Jamaica, NY, USA
Objectives: The objective of this study was to assess realized access, determine 
the existence of equitable or inequitable access and find the factors affecting the 
adherence to the three diabetes care components. MethOds: Behavioral Risk 
Factor Surveillance System (BRFSS) 2010 was used as the data source. Hierarchical 
logistic regression was used to determine equitable or inequitable access to the 
recommended levels of diabetes care. Data analysis was performed using SAS ® 
version 9.2 Results: Realized access was highest for biannual glycosylated hemo-
globin testing (80.30%) followed by annual dilated eye examination (70.39%) and 
daily self-monitoring of blood glucose (SMBG) (63.00%). Hierarchical logistic regres-
sion revealed, enabling resources drove access to recommended level of SMBG and 
HbA1c testing, while recommended level of eye exams were driven by predisposing 
characteristics. Uninsured individuals and those who did not receive diabetes edu-
cation were less least to adhere to diabetes care. cOnclusiOns: Realized access of 
daily SMBG needs to be increased by appropriate measures. The results suggest that 
inequitable access exists for all the three diabetes care components. Thus, measures 
for increasing equitable access are recommended. Knowing the factors affecting 
adherence to diabetes care may assist intervention planners, diabetes educators and 
health care professionals in attempting to improve diabetes management.
PHS85
determining Patient SatiSFaction, PercePtion oF vaLue, and 
monetary WortH aSSociated WitH adHerence Packaging and 
PHarmacy ServiceS
Pinto S.L., Bechtol R.A., Omerza K., Conner T.
The University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA
Objectives: Pharmacists can impact the medication adherence problem by offering 
adherence packaging and specialized services. Evaluating products and services 
that alleviate this dilemma is beneficial for improving patients’ health outcomes. 
Understanding consumer perspectives are important to determine continued use 
and expansion of such products and services. Objectives include to: (1) evaluate 
patients’ satisfaction with the services, (2) assess patients’ perceptions of the value 
of adherence packaging on their medication taking behavior, and (3) determine 
a dollar amount patients’ view as a worthy investment for services. MethOds: 
Patients and caregivers > 18 years of age with at least six medications, three chronic 
conditions, and six months of adherence packaging utilization at a community 
pharmacy in Toledo, Ohio were studied. Services included pharmacist-provided 
counseling, refill synchronization, follow-up phone calls, and delivery services. 
Three structured focus group sessions were conducted. Satisfaction was assessed 
using a survey with a Likert-type scale. Show of hands and discussion were used 
to determine the value/impact on medication taking behavior and outcomes. 
Monetary worth/dollar amounts were obtained through written responses to 
open-ended questions. Responses analyzed using percentages and frequency dis-
tributions. Results: Thirty patients and caregivers participated and 93% (28/30) 
were satisfied with services provided. Participants reported adherence packaging 
and services led to fewer ER visits/hospitalizations and assisted in bringing blood 
sugar and blood pressure closer to goal. Two participants felt adherence packag-
ing was priceless and could not put a monetary value on the product or services. 
Participants reported the following monetary values: up to $50 per month (adher-
ence packaging only), $75 (adherence packaging with delivery), $100 (adherence 
packaging with counseling), and $120 (adherence packaging, delivery, and coun-
seling). cOnclusiOns: Overall, individuals were satisfied and saw value in the 
adherence packaging system and services. Evidence suggests these services posi-
tively impacted health outcomes. Payers and health plans should consider offering 
such products/services to their customers.
PHS86
miLitary veteranS’ PercePtionS oF diSagreement WitH tHeir Provider 
regarding tHeir medicaLLy unexPLained SymPtomS are aSSociated 
WitH LoWer SatiSFaction and intentionS to adHere to treatment 
and Poorer HeaLtH-outcome exPectationS
Phillips L.A.1, McAndrew L.2
1The George Washington University, Washington, DC, USA, 2The State University of New York at 
Albany, Albany, NY, USA
Objectives: Medically unexplained symptoms (MUS) are pervasive amongst 
returning veterans from military operations abroad. Veteran perceptions of MUS 
predict adherence and improvement, but little is known about patients’ perceptions 
of disagreement with their providers about MUS and its effect on adherence and 
outcome expectations. Given the inherent uncertainty on both the patient’s and 
the provider’s part regarding MUS, it is likely that there is much room for disagree-
ment, particularly perceived disagreement on the part of the patient, and a patient 
who disagrees with the provider is less likely to adhere to the providers’ recom-
mendations for treatment and therefore less likely to see improvement in his/her 
condition. This study evaluated the degree to which veterans perceive disagreement 
with their primary care providers regarding the MUS overall and the relationship of 
these perceptions to behaviors and outcomes of interest. We hypothesized that per-
ceived disagreement would significantly predict intentions to adhere, satisfaction 
with care, and expectations for MUS-improvement. MethOds: Veterans (n= 180) 
experiencing MUS reported on perceived disagreement with their provider regarding 
the MUS, intentions to adhere, expectations for MUS improvement, and satisfac-
tion. Results: 33% of veterans perceived no disagreement with their provider, 
22% perceived slight/minor disagreement, 26% perceived moderate disagreement, 
10% perceived quite a bit of disagreement, and 9% perceived complete disagree-
ment. Results were as expected with significant relationships between perceived 
disagreement and intentions to adhere (r(174)= -0.21, p< 0.01) and satisfaction with 
to therapy for any of nine therapeutics classes. MethOds: This prospective rand-
omized trial used claims data from a large pharmacy chain beginning in February 
2013. Patients were randomly assigned to an intervention group that received phar-
macist phone calls to discuss their newly prescribed medication within three days 
after dispensing (n= 219,611) or a control group that received no calls (n= 225,497). 
We tracked patients’ claims data for 180 days to evaluate their medication adher-
ence. Baseline demographic characteristics and therapeutic class distribution were 
compared between groups. Medication adherence was measured by Patient Days on 
Therapy (PDOT) within 180 days for every targeted therapeutic class (anti-anginal 
agents, betablockers, diuretics, anti-asthmatic and bronchodilator agents, genitou-
rinary agents, anti-depressants, anti-Parkinson, anti-coagulants, and hematologi-
cal agents) and overall. Significance was determined using ‘2 and t tests between 
intervention and control groups. Results: Both intervention and control groups 
had similar baseline demographic and therapeutic class distributions (P> 0.05). 
Comparison by therapeutic class found large variations of adherence with hema-
tological agents having the greatest adherence (PDOT= 105.57) while anti-angina 
agents had the lowest (PDOT= 47.06). The intervention group had greater adherence 
than the control group in every therapeutic class with the PDOT differences rang-
ing from 0.48 days for anti-angina agents to 2.63 days for anti-Parkinson agents 
(P≤ 0.05). Overall, the intervention group was more adherent than the control group 
(PDOT 86.27 vs. 84.79, P≤ 0.01). cOnclusiOns: A community pharmacist telephone 
call program improved medication adherence across multiple therapeutic classes.
PHS82
SyStematic Literature revieW oF comPLiance and PerSiStence 
ProgramS in inFLammation and immunoLogy
Burudpakdee C.1, Kaura S.2, Gala S.1, Nanavaty M.1, Khan Z.M.2
1MKTXS, Raritan, NJ, USA, 2Celgene Corporation, Summit, NJ, USA
Objectives: Patient compliance and persistence to pharmacotherapies is impor-
tant, especially in chronic conditions in inflammation and immunology (I&I) 
therapeutic area, to improve patient outcomes. Programs/interventions that aim 
at improving medication compliance and persistence play an important role in opti-
mizing care. Since there is a lack of relevant systematic reviews in I&I, the objective 
of this study is to provide a comprehensive understanding of the effectiveness of 
compliance and persistence programs in the I&I therapeutic area. MethOds: A sys-
tematic literature search was conducted and studies were identified from PubMed, 
conference proceedings and grey literature. Selection criteria included studies pub-
lished in English, German, Spanish, Italian and French languages between January 
2008 and September 2013, that evaluated the impact of programs on medication 
compliance and/or persistence in I&I. Abstracts were screened by two researchers 
for inclusion, and discrepancy was resolved by a third researcher. Selected publica-
tions underwent full review and abstraction. Results: A total of 3,637 abstracts 
were screened, of which 29 evaluated the effectiveness of compliance and persis-
tence programs. Studies reviewed covered different countries: the US (n = 19); Italy 
and the UK (n = 2 each); Australia, Denmark, Malaysia, and Poland (n = 1 each); 
multicenter (n = 1) and unreported/no country mentioned (n = 1). The majority of 
patient programs were conducted in the osteoporosis disease area (n = 9), followed 
by inflammatory bowel disease (n = 4), and multiple sclerosis and ulcerative colitis 
(n = 3 each). The most effective interventions were one-on-one tailored counseling 
and web-based education/communications that improved medication compliance 
by 44% and 31%, respectively. Additionally, group-based motivational and problem-
solving support resulted in improvement of 12% at 24 months. cOnclusiOns: A 
well-developed compliance program can have a significant impact on improving 
patient compliance as well as persistence to therapies. This, in turn may improve 
patient outcomes.
PHS83
tHe reacH oF adequate PHarmacoLogicaL adHerence and tHe time 
neceSSary to imProve it aFter PerForming a PHarmacotHeraPeutic 
FoLLoW uP to a coHort oF PatientS WitH Hiv. February 2012–june 2013
Estrada J.I.1, Serna J.A.2, Restrepo A.M.1, Cardona M.3
1CES University, Medellin, Colombia, 2UPB University, Medellin, Colombia, 3Antioquia University, 
Medellin, Colombia
Objectives: Determine the proportion of patients who improve adherence sub-
sequent evaluated pharmacotherapeutic follow-up (PF), also, Identify the factors 
that explain the improvement of bond and the time necessary to achieve that 
result. MethOds: A dynamic cohort study was performed on patients classified 
as non-adherent (205 patients). Two questionnaires were used (The use of ques-
tionnaires was authorized by the authors), the Simplified Medication Adherence 
Questionnaire developed by Hernando Knobel et al, and the Simplified Medication 
Adherence Scale developed by Ventura-Cerdá et al. The questionnaires were admin-
istered by a pharmacist during consultations of PF in which education was provided 
about the importance of adherence (the number of PF was defined at pharmacist’s 
discretion). The patient left the study when they were cataloged as adherent by both 
questionnaires. For the qualitative variables, absolute and relative frequencies were 
used, and for quantitative variables summary measures were used. For bivariate 
analysis, Log-rank test, T-Student and U-Mann Whitney were used. We worked with 
a confidence interval of 95% and alpha < 0.05. To adjust the association measures 
the Cox Proportional Hazards Model was applied. SPSS® version 21 for Windows 
(SPSS Inc. Chicago, Illinois, USA), covered by CES university was used. Results: The 
61.5% of patients improved adherence, were required 206 days or less to achieve this 
result (interquartile range: 88-460). The number of PF queries performed (p: 0,012), 
the city (p: 0,003) and area of residence (p: < 0,000), showed statistical association 
with improved adherence, of which only the city (HR for Bogota 0.39, IC 0.17-0.87; 
Cali 1.34, IC 0.75-2.4, compared with Medellin) and the number of PF (HR 0.87 IC 
0.79-0.95) maintained their relation for the multivariate analysis. cOnclusiOns: 
The city of residence and the number of PF consultations conducted were associated 
with improved adherence. The education provided by the PF improves adherence 
in patients diagnosed with HIV, classified as non-adherent.


PHS85 Determining Patient Satisfaction, Perception Of Value, And Monetary Worth Associated With Adherence Packaging And Pharmacy Services 

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PHS85 Determining Patient Satisfaction, Perception Of Value, And Monetary Worth Associated With Adherence Packaging And Pharmacy Services

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