Health System Specialty Pharmacies Improve IBD Patient Adherence, Reduce Likelihood of ER visits and Hospitalizations, Study Finds

Logically, not taking medications as prescribed increases the prospect of requiring acute medical care. While patient adherence plays a crucial role across all chronic disease management, the extreme costs associated with specialty therapies puts even more importance on people taking medication as prescribed

Providers, payers, patients — all stakeholders in the healthcare have an interest in finding ways to help patients with chronic disease, such as inflammatory bowel disease (IBD), remain adherent to their treatment plans. Further, previous research has shown that better adherence to specialty medication therapy results in fewer disease flare-ups for individuals with IBD, more specifically ulcerative colitis or Crohn’s disease.

The findings of a study published in Gastro Hep Advances supports the utilization of integrated specialty pharmacies at academic healthcare systems to improve patient adherence metrics and reduce hospitalizations and ED visits.

The group of researchers from Vanderbilt University Medical Center, University of Maryland, and University of Minnesota conducted the study to assess the impact of an in-system specialty pharmacy on adherence and health outcomes.

Lead author Lauren A. George, M.D., of the University of Maryland School of Medicine, and her co-investigators gathered data on 680 IBD patients who received self-injectable biologic medications from an in-system specialty pharmacy. Primarily, the investigators sought to compare the average patient adherence in the trial group to the previously reported adherence standard from regular specialty pharmacies of between 40% and 60%. Secondarily, they scrutinized risk factors associated with nonadherence.

George and the other researchers found that 70% of patients managed by in-system specialty pharmacies were adherent to their therapies, suggesting an adherence benefit provided by these types of pharmacies.

In addition, the results confirmed an association of certain risk factors for non-adherence in IBD patients, as suggested by previous research. The risk factors included female sex, having noncommercial insurance and smoking. Patients with 0 or 1 risk factor remained adherent to their medication 74% of the time. Among those with 4 or more risk factors, adherence occurred in less than 50%. As a such, focusing efforts on patients with these factors represent an opportunity for improvement.

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The findings add to the pile of evidence that adherence translates into less utilization of acute healthcare. Nonadherent patients were 7% more likely to require an emergency room visit compared to adherent patients. Nonadherent patients were also hospitalized more often (28%) compared to patients who adhered to their medications (21%).

George and colleagues stressed, though, that assessing nonadherence is complex. Rather than a causal relationship between a risk factor and eventual nonadherence, a combination of many factors, including many that fall outside of patients’ control, likely contribute to non-compliance.

They also made a point of emphasizing the benefits of health system pharmacies: “Health system specialty pharmacy teams perform patient outreach on a regular basis to assess for medication-related issues and try to improve adherence. The specialty pharmacy team also manages navigation of the insurance approval process which can be a very difficult aspect of continuing biologic therapy for patients.”