Mobile Healthcare Pilot Bolsters Chronic Disease Medication Adherence

An integrated mobile healthcare program focused on patient transitions from hospital to home was able to improve the likelihood of chronic disease medication adherence for patients with lung and heart conditions, according to a recently published study.

When the University of Maryland Medical Center deployed its mobile integrated health-community paramedicine (MIH-CP) program, it focused on decreasing adverse health outcomes after hospital discharge by addressing the medical needs and social determinants of health (SDOH) of chronic disease patients.

Prescribed medication adherence is essential to avoid hospital readmission for those managing chronic disease. Further, patients with poor medication adherence are 2.5 times more likely to experience hospital readmission.

And with research showing that nearly 40 to 50 percent of chronic disease patients face barriers to taking their medications, efforts to bolster uptake have become central to healthcare professionals.

In the study, high-risk chronic disease patients affiliated with the University of Maryland Medical Center were provided follow-up care through the MIH-CP program using pharmacists, medical doctors, nurses, and community health workers to support them through transitional care.

Following hospital discharge, field teams of community paramedics and pharmacy technicians conducted home visits to collect vital signs, review patient medication, and conduct medication assessments.

“The home visit component of this program sets this care transition model apart from other models, which utilize a phone-call or other in-clinic services,” lead study author Olufunke Sokan, PharmD, advanced practice pharmacist at the University of Maryland School of Pharmacy and colleagues, said in a press release. “This is because home visits provide pharmacists with a more realistic picture of a patient's medication-taking behavior, which results in a more thorough post-discharge medication reconciliation. This process helped to identify important changes and discrepancies to patient's medication regimen.”

“During the process of in-home medication reconciliation conducted by the MIH-CP team, several discrepancies were identified including continuation of discontinued medications, therapeutic duplication, omitted medications, incorrect administration such as changes in drug strength, and/or changes to the frequency of their administration among others,” the authors wrote in the study.

A discharge visit at the end of the 30-day program addressed medication changes or any medication-related problems.

The findings showed that 89 percent of MIH-CP patients picked up their newly prescribed medications within 30 days of discharge compared to the less than 70 percent pick-up rate by non-MIH-CP patients. 

Specifically, in the first 30 days after enrollment, prescription fill rates increased by nearly 20 percent for patients with congestive heart failure (CHF) and 25 percent for patients with chronic obstructive pulmonary disease (COPD).

Researchers also noticed improved medication adherence between 8 and 14 percent in the 60 days after a pharmacist-led intervention.

“Pharmacists play a critical role in MIH-CP and similar types of programs by focusing on medication management and adherence,” the study authors explained. “The pharmacist identified cases of first fill failure, where a medication is started in the hospital, but the patient never filled the medication post-discharge.”

Despite the slight improvements, the impact on medication adherence did not continue beyond the 30-day duration of the MIH-CP program, indicating a need for additional follow-up beyond 30 days.

“Efforts to integrate inpatient and outpatient medication regimens remain critical for the prevention of medication non-adherence during transitions of care and help to identify medication non-adherence at timepoints,” said Sokan and colleagues. “Transition of care programs such as MIH-CP, which incorporate pharmacists as part of the team, support the identification and resolution of critical medication-related problems and medication non-adherence. These types of programs can provide much-needed care and support for a largely underserved community.”

Past research has shown that mobile healthcare solutions are adept at addressing medical and social determinants of health to reduce healthcare barriers. The benefits mobile healthcare has to offer have increased over the years.

A separate study regarding community-based mobile health units found that these tools were able to improve COVID-19 vaccine access.

In this case, the study finding showed that mobile health delivery systems were well-positioned to target more Black and Hispanic patients, alleviating some past inequalities and racial disparities certain marginalized groups face related to COVID-19.

These promising findings allowed the program to continue and expand to more communities, increasing the program’s reach to other medically unserved communities of color.