University of Miami
South Florida
Diabetes and Cardiovascular Disease Risk Factors
African American, Latino

Project

Patients receive diabetes medication at their doctor’s office, utilizing an automated medication delivery system.

An automated medication-delivery system allows physicians to fulfill prescriptions for diabetes, blood pressure or cholesterol medicines at the time of the clinic visit. Based on prescriptions entered into electronic medical records, a controlled-access storage cabinet in the clinic office automatically dispenses pre-packaged medications, which are delivered to the patient during their appointment. A four-step quality control protocol, including color-coded labels, ensures that the correct patient receives the proper medication. Containers are labeled with the patient’s name, and patients are provided with a printed summary of the prescription, including instructions and a picture of the pills themselves. The summary can be provided in English or Spanish.

Rationale

Medication adherence is a key component in diabetes management, but many patients fall short of adherence targets. This point of care medication delivery system helps overcome various barriers to obtaining medications and maintaining medication adherence. These barriers include difficulties in the patient’s environment such as transportation to the pharmacy, neighborhood safety, or time constraints. By changing the place where a patient receives his medication (from pharmacy to clinic), this intervention restructures the way a patient receives care.

The medication delivery system links the clinical encounter to the medication-filling process, which has the potential to make adherence issues a central part of the physician-patient interaction. Physicians may gain a deeper understanding of the challenges of the prescribed regimen, and patient barriers to adherence. Patients, in turn, may be able to learn more about the regimen and discuss concerns about the medication during the clinic visit itself. The link between the automated medication-delivery system and the patient’s electronic medical record gives physicians better information about that patient’s adherence.

Summary Results

An automated medication-delivery system did not significantly improve patient outcome measures (LDL cholesterol, HbA1c, and blood pressure) but did significantly increase the proportion of patients with access to medication. The Medication Possession Ratio (access to medication at least 80% of the time) increased 15% for diabetes, 26% for cholesterol, and 32% for blood pressure medications. Continuous medication possession over time increased by 21% for diabetes, 28% for cholesterol, and  21% for blood pressure medications.

Publications

Can Physicians Deliver Chronic Medications at the Point of Care? 
American Journal of Medical Quality. 2015.
Full Article (subscription may be required)

Principal Investigators

• Ana M. Palacio, MD, MPH (Assistant Professor, University of Miami)
• Olveen Carrasquillo, MD, MPH (Chief, Division of General Medicine, University of Miami)