Strengthening value-based medication management in a free clinic for the uninsured: Quality interventions aimed at reducing costs and enhancing adherence.

Autor:	Arao RK; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., O'Connor MY; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Barrett T; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Chockalingam L; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Khan F; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Kumar A; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Leader A; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Leven E; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Power JR; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Shuham B; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Rifkin R; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Thomas D; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Meah Y; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Shah BJ; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2017 Oct 31; Vol. 6 (2), pp. e000069. Date of Electronic Publication: 2017 Oct 31 (Print Publication: 2017).
DOI:	10.1136/bmjoq-2017-000069
Abstrakt:	Skyrocketing costs of prescription medications in the USA pose a significant threat to the financial viability of safety net clinics that opt to supply medications at low to no out-of-pocket costs to patients. At the East Harlem Health Outreach Partnership clinic of the Icahn School of Medicine at Mount Sinai, a physician-directed student-run comprehensive primary care clinic for uninsured adults of East Harlem, expenditures on pharmaceuticals represent nearly two-thirds of annual costs. The practice of minimising costs while maintaining quality, referred to as high-value care, represents a critical cost-saving opportunity for safety net clinics as well as for more economical healthcare in general. In this paper, we discuss a series of quality improvement initiatives aimed at reducing pharmacy-related expenditures through two distinct yet related mechanisms: (A) promoting value-conscious prescribing by providers and (B) improving patient adherence to medication regimens. Interventions aimed at promoting value-conscious prescribing behaviour included blacklisting a costly medication on our clinic's formulary and adding a decision tree in our mobile clinician reference application to promote value-conscious prescribing. Interventions targeted to improving patient adherence involved an automated text messaging system with English and Spanish refill reminders to encourage timely pick-up of medication refills. As a result of these processes, the free clinic experienced a 7.3%, or $3768, reduction in annual pharmacy costs. Additionally, medication adherence in patients with diabetes on oral antihyperglycaemic medications increased from 55% to 67%. Simultaneous patient-based and provider-based interventions may be broadly applicable to addressing rising pharmacy costs in healthcare across the USA. Competing Interests: Competing interests: None declared.
Databáze:	MEDLINE
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