1. Beverly Mielke MD, MPH (R2) PI: Christopher Bryson MD, MS VA HSR&D

2. Few studies focused on organization-level factors that either hinder or facilitate medication adherence Pharmacists are becoming more integral part of primary care clinics, especially through the patient- centered home model

3. The number of pharmacists in VA primary care clinics will be positively associated with medication adherence among patients with diabetes

4. Study Design: Retrospective national cohort study of VA patients Setting: 212 clinics from VA Clinical Practice Organizational SurveyPrimary Care Director Module – 139 VA Medical Centers – 72 community-based outpatient clinics Survey question asked for the number of FTE pharmacists allocated to the primary care program

5. Included facilities with >100 patients with a diagnosis of diabetes and enrolled in a primary care clinic Diabetes definition: Outpatient or inpatient diagnosis AND At least 1 oral hypoglycemic medication Included 304,472 patients

6. Obtained refill data for all patients in the study population Calculated a medication possession ratio Considered to be adherent if they had >80% of their oral therapy regimen during the first quarter of 2007 Calculated an adjusted proportion of patients adherent for each clinic – Adjusted for age, comorbidities, severity of DM

7. For each facility with at least one pharmacist FTE, we constructed the proportion of patients adherent using the medication possession ratio (MPR) Also looked at the association between pharmacy FTE per 10,000 diabetic patients and proportion of adherent patients

9. OHA Adjusted Adherence at Facilities with and without Pharmacists in Primary Care Clinics

10. Pharmacist FTE vs. adjusted OHA adherence among facilities having pharmacists in the primary care clinic

11. Other models also showed no association: Adjusted for number of patients per clinic, number of encounters per clinic, restricted to clinics with pharmacists

12. Use of pharmacy refill data is a good proxy for medication adherence, but isnt perfect Patients may obtain medication outside of the VA system or have changes in their medications Number of pharmacist FTEs does not reflect the role of pharmacists

13. No association between pharmacist FTE and adjusted oral hypoglycemic adherence Pharmacists are helpfulthis study just didnt show it Other factors to consider Telephone wait times Administrative support to facilitate refills Role of pharmacists in the clinics