• Adherence to Mood Stabilizers Using a Pharmacy Prescription Database Analysis: Assessment of the Relationship of Non-Adherence to Hospitalization Rates, Cost of Care, and Gender for Patients with Bipolar Type I Disorder

      Fankhauser, Martha; Slack, Marion; Kale, Andrea; Kuchanskaya, Yuliya; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: This study utilized a prescription claims database to retrospectively assess the relationship between adherence rates with a mood stabilizer in bipolar type I patients for: gender, age, psychiatric hospitalization rates, cost of services, and concomitant psychotropic medications. Methods: Adult patients with bipolar type I disorder (N=149; F=92 and M=57) who received at least two prescriptions of a mood stabilizer (i.e., carbamazepine, lamotrigine, lithium, oxcarbazepine, and valproic acid) during a 3-month intake period were included. Adherence to the mood stabilizer was retrospectively analyzed using high: >75% (> 274 days) vs. low: < 75% (< 274 days) supply of a mood stabilizer during 12-months. Results: Only 35.6% of the patients (N=53) met the criteria for > 75% adherence and 11.4% (N=17) met the criteria for > 90% adherence. There was a trend toward women having more days supply of a mood stabilizer compared to men (p=0.08) and older patients having a higher adherence rate with a mood stabilizer (p=0.06). The high adherence group had greater prescription costs (p<0.001) and total cost per year (R2=0.34, p=0.064) and more concomitant medications (p=0.04) than the low adherence group. Overall, there were no significant differences between the high and low adherence groups for mean hospital days, inpatient costs, and total cost of care. Among those patients that were hospitalized there was a negative correlation between adherence and inpatient cost (R2=0.49, p=0.024). Conclusions: Our findings suggest that patients with bipolar type I disorder demonstrate poor medication adherence with a mood stabilizer and that adherence rates based on a prescription claims database using two adherence categories may not be a predictive factor for psychiatric hospitalizations or cost of care.
    • Physician Response to Pharmacist Statin Therapy Recommendations for Type 2 Diabetes Patients

      Kale, Andrea; Cavender, Cole; Castaneda, Luciano; Nguyen, Steven; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine if the response rate will be greater than the 14% response rate that was shown in the AUDIT study in 2006. The rationale is since statin therapy is recommended as part of the American Diabetes Association (ADA) guidelines, physicians will be more open to the suggestion and the response rate will be higher. Our secondary analysis is that at least an additional 5% of patients will be on statin therapy even though their physician did not respond to the fax. The rationale is that even though a physician may not respond to us via fax, they may be prompted to evaluate statin therapy for their patient and write a prescription for statin therapy. Subjects: Using Albertson’s pharmacy database, patients between the ages of 40 to 75 on metformin were filtered. Methods: This before/after study with independent groups used data obtained from a manual fax and compared the response to a previous study that was done in 2006. Main Results: A total of 26 faxes were sent out to providers notifying them that their patient qualified for statin therapy. A total of 4 responses were received with 1 patient that was appropriately initiated on statin therapy. Conclusions: There were no differences in physician response rates in our study compared to the AUDIT study with recommending statin therapy in patients 40 to 75 with type 2 diabetes mellitus that qualify for statin therapy per ADA guidelines.