Mixed results for pharmacist-led medication management but a smaller group of patients might benefit, study shows

If he had to do it all over again, Joshua Pevnick, M.D., M.S.H.S., would focus on a smaller group of patients.

“If I were doing the trial again, I would say, ‘Let's do it entirely in patients with low medication adherence and literacy,’ and that's where I would look for the effect,” says Pavenick in this segment of a video interview with Managed Healthcare Executive.

Pevnick, an associate professor at Cedars-Sinai Medical Center in Los Angeles, led a study of a pharmacist-led program with the goal of reducing unplanned hospitalizations from adverse drug events. Pevnick and his colleagues enrolled a total of approximately 6,500 patients at Cedars-Sinai and at Brigham and Women’s Hospital in Boston between Dec. 23, 2019, and Dec. 30, 2022.

The results, published last week in JAMA Network Open, were mixed, with the program not producing a statistically significant difference in the overall group of patients. But in a subgroup of approximately 600 patients with low medication adherence and literacy, there was a 10.4 percentage point difference in unplanned hospital or emergency room utilization (69 [28%] of 240 usual care patients vs. 64 [18.3%] of 349 in the intervention group).

The pharmacist-led intervention that he and his colleagues were testing had several components, including predischarge medication review, patient education and medication reconciliation, and postdischarge communication with the pharmacy, primary care provider and patient. Education and communication are shared elements among them, Pevnick notes. “It makes sense that people who don’t have good health literacy and are not adhering to their medications would benefit the most.

Pevnick says there are several possible explanations for why the overall trial didn’t meet its primary end point. The target enrollment wasn’t reached, partly because of the COVID-19 pandemic. Patients in both the intervention and the usual care group received thorough medication reviews upon admission that might have narrowed the difference between the intervention and the usual group. Plus, there was some inconsistency in the application of the intervention.

“This was a pragmatic trial, so we tried to do it in a very real-world setting. And some of the things that go along with that are that we’re not ensuring that the intervention is done perfectly every time,” observes Pevnick.