Pharmacist interventions and patient adherence

The most effective way to get patients to stick with their medication regimens all the way through their therapy, it turns out, is to give the job to community pharmacists. That means giving them time and adequate compensation to do what they do best: counsel and monitor patients, one-on-one.

Behind the common-sense conclusion that pharmacists can be the most effective resource for improving patients' drug adherence rates is a new study from CVS Caremark.

Researchers from the company, working with Harvard University and Brigham and Women's Hospital, concluded that the best way to boost adherence rates was through individual, one-on-one interventions with patients.

“Adherence interventions targeted to patients identified as nonadherent were more effective than broad interventions that cast a wide net to encompass all medication takers,” CVS reported on May 24.

Sarah Cutrona, a former research associate at Brigham and Women's Hospital, went further about the superior effectiveness of targeted, face-to-face encounters with patients by health professionals (i.e., pharmacists) for keeping patients on the path to better outcomes through medication therapy. “Without the benefit of identifying patients and their specific barriers to adherence, [broad-based intervention programs] may be too general to motivate individual patients to change their medication taking behavior,” she said.

Researchers studied nearly 60 peer-reviewed articles on the effectiveness of various types of adherence programs for patients with diabetes and cardiovascular disease. What they found was that “dynamic interventions [32%] and focused interventions [25%] were more likely to show impact on adherence as compared to broad interventions [18%],” according to CVS Caremark.

This kind of targeted initiative — looking into the issue of patient noncompliance and ways to overcome it — is one beneficial byproduct of the unique, dual operating model CVS Caremark pursues as both a retail pharmacy giant and a pharmacy benefit manager with national reach. The company can mount these kinds of large-scale research projects because its reach as a pharmacy and managed-care powerhouse is wide enough to touch many points along the continuum of care and draw conclusions from the data it gathers along that chain of care.

That's why CVS Caremark researchers are able to conclude that the company's drug adherence programs saved its PBM clients $2.4 billion last year “due to improved medication adherence for chronic conditions.”

All well and good in a perfect world. But do pharmacists in most community practice settings have the time to actively intervene in drug adherence and monitoring programs? And does the current pharmacy reimbursement model followed by most health plan payers support these programs? If not now, is the payment model at least evolving to that kind of outcomes-based system? Or are payers still, by and large, locked into silos that reward short-term cost cutting in contract negotiations over the long-term savings and healthier patients that pharmacists can help deliver, if given the opportunity?