The benefits of synchronized refills

A “first of its kind” study in Ontario has shown that an appointment-based model (ABM) in pharmacy practice increases the likelihood of adherence to chronic medications and is convenient for patients.

With funding from the Canadian Foundation for Pharmacy’s Innovation Fund, researchers at the Leslie Dan Faculty of Pharmacy, University of Toronto, conducted a retrospective, pre-post study of 131 patients enrolled in the ABM program at three pharmacies within the Whole Health Pharmacy Partners banner. Researchers analysed 15 months of the patients’ refill data, from September 19, 2017 and December 18, 2018, for three medications—antihypertensives, oral antihyperglycemics and statins.

The patients were taking 5.1 medications on average and more than half (55.7%) were taking five or more medications. They were evenly split between males (48.9%) and females (51.1%) and the mean age was 70.8 years.

The research paper by Qiqi Lin et al., “Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence,” was published online by Research in Social and Administrative Pharmacy in May 2023.

The ABM has two main components:

• Medication synchronization, which aligns all refill due dates to enable patients to pick up all medications at once and at predetermined time intervals. It also eliminates the need for patients to call in for refills.
• A scheduled appointment on the day of pick-up, providing patients the opportunity for one-on-one counselling from the pharmacist and providing pharmacists the time to perform a holistic review of the medications profile and proactively address potential issues.

The study originally sought to quantify the ABM’s impact on adherence, using the common measure of proportion of days covered (PDC). However, participating patients already had high baseline adherence from usual care. The PDC for all three medications was already more than 95%, well above the 80% threshold that’s considered an indicator of adherence. As a result, the ABM program did not have clinically significant effect on adherence. That said, the PDC for statins increased from an already impressive 95.3% to 97.8% after six months and 99.2% after 12 months.

The study also compared the number of distinct refill dates and number of refills. Patients benefited from a significant reduction in refill dates, decreasing from 6.8 times during the six months before implementation of the ABM program to 4.9 during the six months after implementation. Over a 12-month period pre- and post-implementation, the distinct refill dates decreased from 12.9 to 7.0.

Meanwhile, the number of refills increased during the six months pre- and post-implementation, from 11.9 to 13.3. The difference over 12 months was nonsignificant (from 22.0 to 20.1).

Aside from the results on adherence due to the unusually high baseline PDC, the findings are consistent with other studies on the impact of the ABM. From the perspective of patients and caregivers, the upshot is that they made at least two fewer trips to the pharmacy during a six-month period and five fewer trips over 12 months.

“This can make accessing important medications easier, circumventing the risk of nonadherence due to access issues an inconvenience. In addition, for some patients, fewer trips to the pharmacy not only saves money but also transportation-related costs,” noted the study authors.

The authors also suggested that the ABM has “enormous potential to incorporate virtual approaches to medication care to meet the needs of high-risk patients and those who are unable to visit a pharmacy in person.” While the impact on pharmacy workflow was outside the scope of the research, the authors noted: “The predictable workflow facilitated by the ABM may help pharmacists better manage inventory, personnel, and delivery costs, as well as create increased opportunities for scheduled billable services that could both offer a benefit to patients and increase revenue for the pharmacy.”