Patients with chronic conditions and complex drug regimens are at an especially high risk of not taking the medications they need to successfully treat their conditions. And, as former U.S. Surgeon General C. Everett Koop once reminded prescribers, patients and pharmacists, "Drugs don't work in patients who don't take them."
Failure to follow a medication regimen is widely recognized as a top reason1 for treatment failures, serious adverse reactions and even deaths. In addition to poor patient outcomes, medication non-adherence can lead to hospital readmissions and expensive treatments that drive higher downstream healthcare costs.
As accessible and trusted experts, community pharmacists are ideally positioned to positively influence adherence and patient outcomes. Pharmacies can accomplish this by guiding their patients use of their medications. Here is how.
1. Educate patients about what to expect.
New therapies begin with great promise for patients, but when a provider or pharmacy doesn’t prepare a patient for all potential outcomes, he or she may stop taking the drug. If a patient starts feeling better, he or she might think the drug is no longer needed. If he or she feels worse, the patient could discontinue therapy to avoid side effects. If the patient experiences no change whatsoever, he or she may conclude that the drug isn’t working. For new therapies, prescribers may typically spend less than a minute telling their patients how a drug works and how they should expect to feel and the patient often has to initiate more information by asking questions.2 The pharmacist has the opportunity to fill in any gaps and provide an additional level of service to patients. The more time pharmacists spend with a patient to explain his or her condition, how the drug works and why it is important to take the medication consistently, the greater the likelihood that the patient will remain adherent to therapy. Patients with chronic conditions are more likely to stay adherent once they feel assured that their medication is having a positive impact on their overall well-being.
2. Nurture relationships with patients.
Patients see and interact with their pharmacist much more often than with their prescriber. Pharmacists and pharmacy staff should take at least a few minutes to talk and establish a relationship with every patient who walks through the door. This step can make a world of difference in a patient's life. Pharmacists should ask patients how they are feeling, if a new dosage is working better or if they are experiencing any new side effects, for example. All of these questions can start a conversation and allow a patient to open up about concerns that could possibly lead to non-adherence later. And since patients may have more questions once they are on therapy than before they begin therapy, a regular, open dialogue is important for building trust.
3. Team up with prescribers.
Good communication between the prescriber and the pharmacist is critical. Pharmacists can connect with a prescriber and say, “We have 30 mutual patients that use my pharmacy. Most are adherent to their therapy, but here is a potential issue that I see with adherence on a few patients." This builds the understanding that both parties are on the same healthcare team. With the growth of accountable care organizations (ACOs) and evolving payer oversight, this type of model is becoming more prevalent as the health care team is evaluate on improving patient outcomes. This has an added benefit of giving patients the important sense of belonging to a team that regularly communicates about their care. Many independent pharmacies are involved in community activities outside of their business, which provides opportunities to meet prescribers and interact in person, building deeper relationships.
4. Engage the staff.
An efficient and team-based workflow benefits the pharmacy and its patients. Pharmacists can engage the whole staff regularly by holding staff meetings and discussing everyone’s role in caring for patients. Posting CMS Star Quality Rating3 scores in the back of the pharmacy can engage the staff and stress the importance of managing a patient’s care. Web-based tools like EQuIPPTM (Electronic Quality Improvement Platform for Plans & Pharmacies) gather pharmacy claims data from health plans and PBMs and produce monthly scorecards that can be shared among the pharmacy staff. When everyone—from the front-end clerk to the pharmacy technician—embraces their role as a part of the care team, patient engagement improves. Team members are more likely to tune into even casual comments from a patient like, “I’m so tired of taking that pill,” a clue that there could be a problem. A brief talk with the pharmacist may help prevent nonadherence down the road. When a patient calls in and requests a refill, the pharmacy technician can open up the patient’s profile, look at the other medications and ask, “I see you’re also due for a refill on another prescription; would you like that filled today as well?” If the patient declines, the technician can offer a conversation with the pharmacist to further engage the patient and determine why the medication is not being refilled.
5. Learn about and use available technologies.
Having systems in place to monitor and track patient adherence, proactively communicate and document interactions can save pharmacies a lot of time and costs while improving patient outcomes. Pharmacies should look for reporting tools that provide real-time access to patient profiles and visibility into trends over time. For example, PrescribeWellness has a Patient Engagement Center, which, with a couple of clicks, can identify patients taking non-insulin diabetes, hypertension (RASA) and cholesterol (statins) that are non-adherent to their current therapy. Some pharmacy systems also have the capability to highlight non-adherent patients for pharmacy interaction. The key is to implement tools and or processes to allow pharmacies to more effectively target patients that need the most care.
6. Help patients customize their support tools.
Understanding the various adherence tools available and how they are positioned to meet an individual patient’s preferences can have a measurable impact on adherence. Some patients may embrace a new app for their smartphone, while others might find a simple daily pill box to be just right. Compliance packaging; sorting all pills into easy-to-manage packages that detail frequency and time of day to take, may be ideal for patients on complex drug regimens. It’s not one size fits all, so asking a few questions about preferences is a good idea before making a solution recommendation; and following up and adjusting course may be necessary to get it right. More and more, patients are taking control of their own outcomes and looking at tools for managing their healthcare. Make it easy by helping them along the way, encouraging adherence and keeping them on course.
7. Schedule appointments.
Community pharmacies are busy operations. At any given time, a phone is ringing, the fax is running and the line at the counter is growing. Finding time to speak with patients about their medications and conducting medication reviews, such as formal medication therapy management (MTM), can be a real challenge. Pre-scheduling appointments can help alleviate some of the pressure to have patient conversations during the busiest hours. Very successful pharmacists manage their workflow by planning for incoming prescription refills rather than reacting to the next script in the queue. Planning also allows a business to have an appropriately sized staff and inventory, as well as time for appointments. Unlike visiting a doctor’s office, people show up at the pharmacy whenever it’s convenient for them. Busy times are inevitable, but the more control a pharmacy has over its workflow, the better the patient experience.
8. Synchronize medications.
Coordinate all medication refills for patients to pick up at the same time each month. This ensures a lack of interruptions in therapies and provides a better overall experience for patients—no more walking out with missing scripts or partial fills. Medication synchronization also helps with time management and creating more opportunities for MTMs and counseling. More patients enrolled in medication synchronization leads to more predictable daily prescription volume for a pharmacy. Once volume is more predictable, pharmacies can schedule staff and order inventory more efficiently.
9. Take advantage of MTM platforms and CMR opportunities.
The MTM process and comprehensive medication review (CMR) summaries allow for more one-on-one conversations with patients and will help uncover adherence issues. The education provided with these consultations not only improves a patient’s health and well-being, but also results in increased prescription volume and services. Health plans are not wavering on their commitment to these opportunities to reveal adherence problems and even the potential for future non-adherence.
A rise in Star Quality Rating scores is one way a pharmacy can measure their impact on patient medication adherence. Although not a real-time indicator, Star ratings are certainly a good measure of pharmacy performance and the adherence of patients. Logging into tracking tools at least once a month to check performance and see trends over time provides additional visibility. Of course, the ultimate measure is simply an uptick in prescription refills.
Community pharmacists often find themselves inundated with day-to-day tasks; more on creating critical patient interactions in "Time for Care."
1. Jimmy, B.; Jose, J. (2011). Patient Medication Adherence: Measures in Daily Practice. Retrieved November 9, 2016, from Oman Medical Journal, pp. 155-pp. 159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/
2. Tarn, D., Paterniti, D., Kravitz, R., Heritage, J., Honghu, L., Sue, K., Wenger, S. (2008, April 11). Retrieved November 15, 2016, from Patientient Education and Counseling, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582184/
3. Five-Star Quality Rating System. (2016, October 26). Retrieved November 9, 2016, from Centers for Medicare & Medicaid Services, https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html