Effect of a pharmacy comprehensive chronic diseases care plan on use of lipid-lowering drugs among patients with hypertension

BACKGROUND: The management of chronic diseases is a continuing challenge for health care systems and patients. OBJECTIVE: To assess the effect of a pharmacist-specific chronic diseases management incentive plan (the Comprehensive Annual Care Plan [CACP]) implemented by the government of Alberta (Canada) on adherence to lipid-lowering drugs (LLD) among patients with hypertension. METHODS: We conducted a cohort study of patients with hypertension who received the CACP between 2012 and 2015, using administrative health data. Patients who qualified to receive the CACP but did not receive it were selected as controls. Adherence was assessed 1 year before and after the CACP as the proportion of days covered (PDC) by any LLD. We conducted 2 distinct logistic regressions to assess the likelihood of an increase of the post-CACP PDC by 0.20 among patients with poor pre-CACP adherence (i.e., pre-CACP PDC < 0.80), and the post-CACP PDC decrease by 0.20 among those with previous good adherence. RESULTS: Data for 12,763 CACP patients and 14,555 controls were analysed. CACP patients who had a pre-CACP PDC < 0.80 were more likely to increase their PDC compared with controls (44.7% vs. 37.8%; adjusted odds ratio [aOR] = 1.34; 95% CI = 1.22-1.46). Conversely, CACP and control patients with a pre-CACP PDC ≥ 0.80 had similar likelihood to decrease their PDC (13.4% vs. 14.1%; aOR = 0.96; 95% CI = 0.88-1.04). CONCLUSIONS: The pharmacy CACP was associated with a modest improvement of adherence to LLD. The incentive system for improved care seemed more effective among patients who had low baseline adherence rates with minimal effect in those with previous good adherence.