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Lurie N, Bunton A, Grande K, Margolis G, Howell B, Shrank WH. A Public-Private Partnership for Proactive Pharmacy-Based Outreach and Acquisition of Needed Medication in Advance of Severe Winter Weather. JAMA Intern Med. 2017;177(2):271–272. doi:10.1001/jamainternmed.2016.7208
In the setting of a natural disaster, patients with chronic conditions may have difficulty accessing their prescribed medications, because they are left behind in an evacuation or because a refill cannot be obtained from the pharmacy in the aftermath, which happened after hurricanes Sandy and Katrina.1,2 Some natural disasters are forecasted several days in advance of their arrival, providing an opportunity for preparedness by the public and private sectors. Communication with patients about upcoming storms and the need to refill medications may ensure medication access and prevent exacerbations of chronic diseases. In a collaboration between the US Department of Health and Human Services and CVS pharmacies, we assessed whether consumer-centric outreach to encourage medication acquisition would increase access to prescribed medications.
On January 20, 2016, the Department of Health and Human Services identified Jonas, a blizzard projected to affect the Mid-Atlantic United States, as having the potential to restrict the public’s ability to get to their pharmacies. On January 21 and 22, before the storm, CVS pharmacies contacted 2.1 million patients who were taking long-term medications, had filled a medication in the past 90 days, and were customers at more than 600 stores in Maryland, Virginia, West Virginia, Kentucky, and Washington, DC, urging them to check their medication supply. Of those customers, 1.28 million contacts were via automated telephone calls and 702 000 via text message, based on customers’ prespecified preferences (anticipatory outreach group). For comparison, no anticipatory outreach was delivered to customers of the same stores with 20 randomly selected dates of birth (control group). This evaluation was considered a quality improvement initiative. As such, the evaluation is not considered to be research under the Health Insurance Portability and Accountability Act (HIPAA), and therefore the use of patient data for this purpose does not require an institutional review board waiver under HIPAA.
The primary outcome was medication acquisition within 48 hours of January 21, when outreach began. We compared rates of medication acquisition between the anticipatory outreach and control groups overall and stratified by preferred outreach modality (telephone call and text message). As a secondary outcome, we compared rates of medication acquisition within 7 days among patients whose refill records suggested they had 7 days’ supply or less on hand, overall and stratified by medication type. Analyses were conducted using SAS software (version 10; SAS Institute Inc), using a χ2 test and P ≤ .05 for statistical significance.
Overall, 2 377 851 customers (39.2% male; 60.8% female; mean age, 42.7 years) were included in this study. Customers in the anticipatory outreach and control groups were largely similar (Table 1). Within 48 hours, 4.5% of patients in the anticipatory outreach group refilled a medication, compared with 4.1% in the control group (odds ratio [OR], 1.09; 95% CI, 1.06-1.12), representing an approximately 9% increase in the 48 hours after outreach. These findings were consistent when stratified by whether the preferred outreach modality was text message (5.5% vs 5.2%; OR, 1.06; 95% CI, 1.02-1.11) or telephone call (4.0% vs 3.6%; OR, 1.11; 95% CI, 1.07-1.16).
Among patients whose refill records suggested they had 7 days’ supply or less on hand, patients in the anticipatory outreach group were more likely than controls to refill a medication within 7 days (26.9% vs 26.3%; OR, 1.03, 95% CI, 1.00-1.06) (Table 2). However, this effect was not consistent across medication types and was most notably observed among patients taking antiseizure medications (29.7% vs 26.1%; OR, 1.20; 95% CI, 1.02-1.41).
Building strong partnerships between public and private entities is critical to fostering public health resilience within communities, particularly in the face of natural disasters.3 Such a partnership between the federal government and a large national retail pharmacy chain allowed for the rapid execution of a pragmatic intervention that was associated with small but clear increases in acquisition of chronic medications as Blizzard Jonas approached the Mid-Atlantic region in 2016. Our study has important limitations, including that outreach was provided by a single pharmacy chain, the study had a focus on medication acquisition as opposed to clinical outcomes, and it had smaller sample sizes for analyses by medication type. However, this experience highlights the promise of broader public-private partnerships to leverage retail pharmacies in preparing patients for future natural disasters.
Corresponding Author: William H. Shrank, MD, MSHS, Insurance Division, University of Pittsburgh Medical Center, 600 Grant St, US Steel Tower, 55th Floor, Pittsburgh, PA 15219 (email@example.com).
Published Online: December 5, 2016. doi:10.1001/jamainternmed.2016.7208
Author Contributions: Ms Grande and Dr Howell had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Lurie, Bunton, Margolis, Shrank.
Acquisition, analysis, or interpretation of data: Lurie, Bunton, Howell.
Drafting of the manuscript: Lurie, Shrank.
Critical revision of the manuscript for important intellectual content: Lurie, Bunton, Margolis, Howell.
Statistical analysis: Lurie, Howell, Shrank.
Administrative, technical, or material support: Margolis, Shrank.
Study supervision: Shrank.
Conflict of Interest Disclosures: Mr Bunton, Ms Grande, and Drs Howell and Shrank reported being employees of CVS Health at the time of this study. Dr Shrank reported being a current employee of the Insurance Division, University of Pittsburgh Medical Center. No other disclosures were reported.
Funding/Support: This outreach and evaluation activities of this study were supported by CVS Health.
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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