Pharmacy closures appear to impact cardiovascular medication adherence among older patients, according to findings from a retrospective cohort study published in JAMA Network Open.
To examine this association, the study authors analyzed prescription claims for patients ≥50 years old using statins, β-blockers, and oral anticoagulants between January 2011 and December 2016. “The differential association of pharmacy closure was examined as a function of baseline adherence, pharmacy, and individual characteristics,” explained the authors. The main outcome measure of the study was the difference in monthly adherence during 12-month baseline and follow-up periods among patients whose pharmacy closed (closure cohort) and those whose pharmacy did not (control cohort).
Results showed that among the 3,089,803 patients who filled ≥1 statin prescription during the study period, 92,287 patients (3%) filled it at a pharmacy that eventually closed. While monthly adherence was found to be similar among both cohorts before the pharmacy closure, a significant decline in statin adherence was noted in the closure cohort immediately after pharmacy closure in the first 3 months (absolute change: −5.90%; 95% CI, −6.12% to −5.69%) and persisted over 12 months. “A similar decline in adherence was observed when examining cohorts using β-blockers (−5.71%; 95% CI, −5.96% to −5.46%) or oral anticoagulants (−5.63%; 95% CI, −6.24% to −5.01%),” the authors reported.
In addition, the difference in adherence was found to be greater when looking at certain subgroups in the closure cohort such as patients who utilized independent pharmacies (−7.89%; 95% CI, −8.32% to −7.47%), as well as those living in areas with fewer pharmacies (−7.98%; 95% CI, −8.50% to −7.47%).
Based on their findings, the authors concluded that pharmacy closures do have a significant impact on medication adherence in older patients. “Our findings underscore the substantial influence of system-level factors beyond the high cost of prescription drugs on medication nonadherence, especially among patients at highest risk.”
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