Pharmacists wield new tool in campaign to boost compliance

There’s nothing like 125,000 needless deaths a year and billions of dollars in waste to raise awareness among policy-makers and patient advocates about the acute problem of medication errors and patient noncompliance.

A spate of recent news reports and growing cries of alarm from health care advocacy groups and policymakers have pushed the issue high up the list of the nation’s health concerns. They paint a stark picture of patients’ lack of adherence with drug therapy and its costs.

“Between 50 [percent] to 90 percent of patients do not take their medications according to recommended instructions,” said just-retired Walgreen Co. chairman David Bernauer, citing a study from the Institute for Safe Medication Practices. “In the [United States] alone, non-adherence has been estimated to cost over $100 billion each year. That includes about 10 percent of additional hospital admissions and 23 percent of additional admissions to nursing homes.”

The problem of non-compliance remains a persistent national health care challenge, agreed the National Community Pharmacists Association and Pharmacists for the Protection of Patient Care. In a jointly sponsored poll of 1,000 adults in late 2006, NCPA and P3C noted that Americans’ lack of adherence with a doctor-prescribed drug regimen is widespread among all income and age levels, and not restricted to lower-income patients.

Most striking, according to researchers, is that nearly 3 of-every-4 consumers admit they don’t always take their prescription medications as directed. Researchers found “a major disconnect between consumers’ beliefs and their behaviors when it comes to taking medication correctly, as well as a golden opportunity for pharmacists to use their specialized training and accessibility to help improve patient compliance and health outcomes.”

Improvements in prescription compliance remain an elusive goal, researchers for NCPA and P3C found. Nearly half of those surveyed, 49 percent, said they had forgotten to take a prescribed medication, and 31 percent reported that they had not filled a prescription they were given.

Nearly one-quarter of respondents, 24 percent, said they had taken less than the recommended dosage of a prescription, and 11 percent said they had substituted an over-the-counter medication for the one prescribed.

“These findings are very disturbing,” said Bruce Roberts, NCPA executive vice president and chief executive officer. “They suggest that patients aren’t fully aware of the implications of not taking the right dose of medicine at the right time. Even more surprising, fewer than half indicated they had consulted their doctor or pharmacist before making these changes.”

“We absolutely have to get across the point that if patients don’t take their medication—or they take half their proper dose—health care costs are actually going to rise faster, because then people are going to utilize emergency rooms,” noted Walgreens chairman and chief executive Jeff Rein earlier this year.

Rein’s call to action points to both the problem and the opportunity that patient non-adherence represents to retail pharmacies. The growing use of electronic prescribing, electronic patient record-keeping, electronic transfer of patient records and other applications of health information technology are handing pharmacists, physicians and health plan payers a powerful new tool in the campaign to boost patient compliance and reduce medication errors.

The key, Bernauer said, is to give pharmacists “the systems and tools to do this work efficiently.

“Once our pharmacists have access to relevant patient medical information, the stage will be set for them to greatly improve the appropriate use of medicines—and for us to prove the benefit of their interventions,” Bernauer said in his first address as 2007 chairman of the National Association of Chain Drug Stores.

Bernauer also called the “growing role of government and private industry to push patient compliance” a positive trend “that bodes well for patient health, control of health care costs and pharmacies like Walgreens.”

A new study from the Gorman Health Group sponsored by the Pharmaceutical Care Management Association asserts that e-prescribing could prevent up to 1.9 million medication errors over the next decade if physicians utilized the technology in Medicare. “Along with reducing medication errors, the study also found that even after providing funds for equipment and training, the federal government could save $26 billion,” the PCMA noted.

The PCMA unveiled a new print ad July 19 to drive home that message. The ad features a baseball scoreboard that highlights the 1.9 million medication errors and urges Congress to “get in the game” by requiring Medicare doctors to use e-prescribing.

One thing is clear: pharmacists are on the front line of patient-compliance initiatives. Researchers for NCPA and P3C found that patients “appeared open to tapping into the unique expertise of their pharmacist in order to improve medication adherence.”

Indeed, noted the NCPA/P3C report, more than 8-outof-10 adults agreed that “pharmacists can play a role in improving adherence by helping to make sure patients take their prescription medications correctly.” Additionally, 68 percent of those polled said pharmacists are more knowledgeable than other health care professionals when it comes to information about prescription medications.

“Two-thirds of consumers said they go to one pharmacy for all their prescription medications,” said Ian Salditch, P3C’s founder. “This presents an excellent opportunity for pharmacists to help educate patients about how to take their medications properly.”

Closely related to efforts to boost compliance and patient safety is a major push by the White House and the Food and Drug Administration to improve the safety of drugs already approved and on the market. To that end, the Bush administration’s federal budget for fiscal 2008 includes a $139 million plan to improve post-market drug surveillance by the FDA.

Among the planned improvements: creation of a far more robust database for the safety and efficacy of drugs already being dispensed, and upgrading the Adverse Event Reporting System to “enhance tracking of safety signals,” according to the budget plan.