When Pharmacies Close, Medication Adherence Drops

Pharmacy closures led to a significant drop in adherence to essential cardiovascular medications among US older adults that persisted through 12 months of follow-up, according to a study in JAMA Network Open.

“Efforts aimed at reducing barriers to prescription medication adherence should consider the role of pharmacy closures,” researchers wrote, “especially in patients at highest risk.”

The retrospective cohort study included 3.1 million men and women age 50 and older who were prescribed  statins, β-blockers, or oral anticoagulants. Before a pharmacy closure went on to affect 3% of the study population, researchers found no differences in monthly adherence between the cohorts.

During the first 3 months after pharmacy closure, however, older adults whose pharmacy closed averaged a 5.9% decrease in statin adherence, a 5.71% decline in β-blocker adherence, and a 5.63% drop in oral anticoagulant adherence, researchers reported. The statistically and clinically significant difference in cardiovascular medication adherence persisted throughout 12 months of follow-up.

In most cases, medication adherence declines reflected a complete discontinuation of medicine rather than worsening or partial adherence, according to the study. Compared with 12.8% of older adults whose pharmacy did not close, 23.8% of older adults whose pharmacy closed did not refill their statin prescription at any time during the following year.

“Declines in adherence were most pronounced among older adults using independent pharmacies, purchasing from a single store to fill all their prescriptions, or living in low-access neighborhoods with fewer pharmacies and were consistent across several classes of cardiovascular medications,” researchers wrote. “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.”

—Jolynn Tumolo

Reference

Qato DM, Alexander GC, Chakraborty A, Guadamuz JS, Jackson JW. Association between pharmacy closures and adherence to cardiovascular medications among older US adults. JAMA Network Open. 2019 Apr 5;2(4):e192606.