Medication management and counseling can have a positive impact on specialty pharmacy patients.
A targeted review funded by AbbVie, Inc revealed that patient support programs (PSP), including medication management and counseling, can improve adherence and treatment outcomes.
Researchers collected data from studies that described PSPs implemented for chronic disease therapy, and were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for reviews.
In the study, PSPs were defined as interventions given to patients with chronic diseases that required chronic and/or complex medication therapy to manage the symptoms and control disease progression. The search lasted for 10 years and ended in March 2015.
The PSP studies included were required to have at minimum counseling for medication management, measurement of ≥1 clinical outcome, and a 3-month follow-up period where the outcomes were measured. Data was abstracted and analyzed to understand the types of programs and their related outcomes.
Program-related adherence, clinical, health care cost, and humanistic outcomes were characterized by positive, negative, mixed, and unclear results. Positive was defined as statistically significant results indicated for all primary and secondary endpoints; negative had results with no significant differences in any measure; mixed indicated that results both met and failed endpoints; and unclear results were not adequately described to determine program impact.
There were 2239 records reviewed, but only 64 met the criteria and were included in the study.
The results of the study showed that a majority (75%) of programs offered in-clinic service, including face-to-face support with a health care provider. All but 9 were overseen by allied health care professionals such as pharmacists, nurses, physicians, and paraprofessionals.
All of the studies measured at least 1 clinical endpoint in the program evaluation. Of these studies, 43 also measured a humanistic outcome, 41 measured adherence, and 15 measured an economic/utilization outcome.
There were 41 (64.1%) of assessed programs that reported at least one significantly positive outcome. Of the 41 that measured 1 or more adherence outcomes, 27 (65.9%) reported a significantly positive adherence endpoint. For humanistic outcomes, 27 (64.3%) reported significantly positive results.
There were only 15 programs that reported an economic outcome, 12 of which had at least 1 significantly positive economic endpoint. The study quality and overall strength of evidence was reviewed using standard criteria.
Some limitations to the study included: probable publication bias because of the nature of a systematic review that synthesizes information from already existing literature; inclusion criteria required articles to be published in English, were likely to be cited more frequently, and presented as a positive study; most of the included trials were less methodologically robust and even RCYs relied on heterogeneous control arms (usual care); and the evaluated literature included quasi-experimental, prospective observational cohort studies, retrospective cohort studies, and RCTs.
This review is the first to broadly evaluate the impact of PSPs on clinical, adherence, humanistic, and economic outcomes, the researchers wrote. The findings suggest that PSPs have a positive impact on patient outcomes. Although health care utilization and costs are less frequently measured, both were found to decrease following the implementation of PSP.
Further research still needs to be done to determine which support programs, delivery methods, and components offer the best value and are most effective, the study concluded.