A Look at How Pandemic Disruptions Affected Statin Adherence

Brian Sistani, PharmD, PGY-1 managed care pharmacy resident, spoke with Integrated Healthcare Executive about his research on how the COVID-19 pandemic impacted patient adherence to statin therapy within a large health plan.

Can you please tell us about your research?

We looked at how COVID-19 impacted medication adherence. Using proportion of days covered (PDC) is a very critical way to look at medication adherence, so we wanted to compare the year prior to COVID-19 (March 2019 through February 2020) to the year immediately following COVID-19 (March 2020 through February 2021). When COVID-19 first hit, many of us stayed home if we could, so we expected a decline in PDC. 

Using Medicaid claims history, we were able to investigate and see which areas of Washington, DC, had the biggest decline in PDC from year 1 to year 2. We studied differences in PDC across a variety of demographic groups and used a paired samples T test to confirm the results. Our baseline characteristics show most participants were Black or African American, which represents a majority of the patient population in DC. 

PDC in the overall sample declined by 11.8% from year 1 to year 2. One surprising finding was that among patients on any intensity of statin therapy, the biggest drop in PDC occurred in patients aged 18 to 34 years (34.5%). Typically, statins are prescribed for older patient populations. If older patients experience stroke or have high low-density lipoprotein cholesterol, providers want to use statins for either primary or secondary prevention. 

How do you think these findings can be applied?

More social determinants of health (SDoH) data will become available from a program called Socially Determined. I will be able to use a patient’s address to determine how far they are from the nearest pharmacy; if they are in a food desert; whether they have access to transportation; and other things that impact medication adherence and access.

I think SDoH data will play a major role in identifying vulnerable areas and specific wards in DC. If we can do it, we need to go into the community with nurses, case managers, and social workers to educate patients on statin adherence. Obviously, it takes a lot of manpower to do that.

Last year, our health plan partnered with a digital pharmacy. An enrollee can download the app, and we can also order the medications for them. The pharmacy partners with DoorDash to deliver medications to the patient's home and workplace. We have even delivered medications to the patient's hospital upon discharge. This is another way to increase access to medications, decrease that barrier, and hopefully keep patients as healthy as possible through adherence to their medications. 

That is my call to action: trying to find different ways that health plans can not only improve the overall health of the patient but also our quality ratings. How can we keep patients out of the hospital? Being a preventive or secondary preventive medication, statin adherence goes a long way.