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Measuring a Bespoke Service
Mike Da Gama
Predictive analytics plot possible health outcomes and choices for a patient based on their history and behavioural profile. It is artificial intelligence put to quality use in choosing medications and management strategies, minimising guesswork and the apparent unpredictability of patient adherence.

Could there be a more effective way for pharmacists to analyse their data to actively manage patient health? Predicting patient health outcomes using new machine-learning techniques, then alerting pharmacists to patients at the greatest risk of adverse health outcomes and who may benefit from pharmacist intervention, may improve the effectiveness of pharmacy-based interventions.1

The general idea is that the pharmacy can identify at-risk patients by scanning dispensing information. This can reveal patterns in prescription refill behaviour for patients who do not appear to be refilling at a frequency that would indicate good medication adherence.2 With some form of intervention, could adherence be improved?

This may address the issue of poor medication adherence that has been observed in clinical trials to diminish the benefits of medication.3,4 In contrast, a 2014 systematic review of patient-centred interventions found that augmented pharmacy services had the most evident benefits in improved adherence when medication regimens were tailored to ongoing patient needs, and in cost reduction.5 These interventions were delivered by pharmacists or pharmacy staff to primarily elderly patients with complex medication needs and comorbidities, and commonly involved multiple avenues for interactions with patients, including face-to-face and telephone encounters.

Evidence supporting the effectiveness of the interventions in improving adherence was mixed but significant positive changes were observed more often than negative or non-significant findings. Overall, patient cost and utilisation outcomes were measured following augmented pharmacy services more frequently than for other types of interventions such as physician-led patient education, shared decision-making, case management, etc.5

1 Blalock SJ, Roberts AW, Lauffenburger JC, et al. The Effect of community pharmacy–based interventions on patient health outcomes: a systematic review. Medical care research and review 2013;70(3):235-66.

Pharmacy Guild Australia. MedScreen Compliance Program, URL: http: //< http://www.guildlink.com.au/guildcare/products/guildcare-programs/patien... accessed 13/09/2017.

3 Lee JK, Grace KA & Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006;296(21):2563–71.

4 Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 2002;162(10):1149–55.

5 Kuntz JL, Safford MM, Singh JA, et al. Patient-centred interventions to improve medication management and adherence: A qualitative review of research findings. Patient Educ Couns 2014;97:310–26.