Pharmacy-based adherence efforts: The value of face-to-face interventions
“Drugs don’t work in patients who don’t take them.”
That obvious but overlooked truism, uttered by the late former U.S. surgeon general C. Everett Koop, sums up the nagging and very expensive problem of medication nonadherence. The failure of many patients to take their medicines as prescribed, abandoning prescription therapy in the course of treatment or failing altogether to even fill a written prescription, is one of health care’s most challenging choke points. It compromises successful health outcomes and costs an estimated $300 billion a year in unnecessary hospitalizations, physician interventions and other costs.
Three-in-4 Americans admit in surveys that they don’t always take their medications as directed, according to the National Consumers League, and as many as one-third do not fill all their prescriptions. “The result is a high rate of both medication errors and readmissions to hospitals for patients whose illnesses could have been managed at home,” the University of California-San Francisco reported.
“Medication nonadherence is one of the greatest and most costly barriers in treating illness today,” said Kristi Rudkin, senior director of product development and adherence for Walgreens Boots Alliance. “By developing programs and services that can help reduce these barriers, and examining ways to drive cost savings and improved health outcomes through better adherence, we can help more people get, stay and live well.”
Doug Long, VP industry relations at research giant IMS Health, says adherence breakdowns and medication errors lead to 4 million hospital admissions and 1.4 million outpatient visits per year. “Almost 10% of the 3.6 billion retail prescriptions written by physicians [were] not dispensed to patients” in 2013, he said.
Indeed, some 25% of patients prescribed medications for a new illness fail to fill their initial prescription, and “half of patients taking maintenance medications for a chronic disease stop taking their medications within a year of starting therapy,” CVS noted in a report.
Pharmacists a ‘go-to source’
Faced with those daunting statistics, health plan payers and health advocacy groups have turned to the nation’s 65,000 community pharmacies for help. “A patient with a chronic heart condition who does not take their medications as directed can clearly endanger their health,” said Sue Nelson, VP of federal advocacy for the American Heart Association. “Pharmacists are a key go-to source for these patients. They can arm them with the critical information they need to successfully manage their medications.
“Additional research, education and awareness on adherence also can increase our understanding of best practices and interventions that ensure patients take control of their health,” Nelson said.
Pharmacy chains and independents have responded with an all-fronts campaign to track and improve Americans’ medication adherence rates, achieving significant results by leveraging a core competency of community pharmacy — the trust patients already have in their local pharmacist.
Building on the relationships already established between patients and practitioners — and on powerful, computer-driven analytical systems that can identify patterns of nonadherence within patients’ privacy-protected prescription records — the pharmacy industry has emerged as the health system’s primary resource for improving adherence.
“Our research has shown that pharmacists are among the most effective health providers in encouraging medication adherence among patients,” said William Shrank, M.D., SVP and chief medical officer for provider innovation at CVS Health. “Many patients see their pharmacist more often than their doctor, and that face-to-face interaction and counseling can provide important insights as to why a patient isn’t adherent and how to address their issues.”
Extensive research proves the effectiveness of face-to-face interactions between pharmacists and patients in keeping people on track with their prescription therapy. One study in 2010 by a team of researchers from Harvard University, Brigham and Women’s Hospital and CVS found that “pharmacists at a retail store are the most influential health care ‘voice’ in getting patients to take medicine as prescribed.”
“Pharmacist contact with patients and their doctors increases patient medication adherence rates and physician initiation of prescriptions. The greatest improvements can be seen in patients counseled face-to-face at retail pharmacies,” CVS reported.
The 2010 research, based on a review of more than 40 years of studies published in medical journals, showed that nurses talking with patients as they are discharged from a hospital are the second most influential voice encouraging patients to stay on their medicines. “Both in-store pharmacists and hospital-based nurses are more effective than pharmacists communicating to a patient via the telephone or doctors instructing patients regarding prescriptions,” researchers reported.
Reducing expensive hospitalizations
“We know that pharmacists and nurses are among the most trusted healthcare professionals. Trust translates into effective patient communications,” said Troyen Brennan, M.D., EVP and chief medical officer at CVS.
Walgreens’ Rudkin agrees, “We feel that part of understanding why a patient doesn’t take their medication — and part of the willingness of the patient to share that information — is based on that relationship with the pharmacist. That’s not to say call centers aren’t appropriate, but there’s a lot of pharmacists who know their patients really well. And if we really want to solve the problem, we have to get to the heart of what the problem is, ... and identify gaps in care.
“We do other things, like automated refill reminder calls, email and text reminders that do help patients without that personal touch,” Rudkin added. “But it’s really about deciding who we feel is at most risk, and what level of interaction that patient needs. Driving adherence is more about personalizing that interaction with the patient so that it’s relevant to them, and then providing the pharmacist with that relevant information to have a good conversation with the patient.”
Smaller regional pharmacy chains are no less determined to contribute to the adherence effort. Thrifty White Drug, the Plymouth, Minn.-based chain of 87 drug stores, has enrolled thousands of its patients to its synchronized monthly prescription refill system, which simplifies the refill process by letting patients pick up all their prescriptions in just one pharmacy visit per month. By doing so, the chain is shifting those patients to an appointment-based pharmacy care model, where patients come into the store for periodic, face-to-face counseling sessions with the pharmacist that not only improve adherence but patients’ overall health, according to company president and CEO Bob Narveson.
Hy-Vee, the West Des Moines, Iowa-based supermarket and pharmacy chain, assigns each patient in its specialty pharmacy unit a Hy-Vee Pharmacy Solutions Pharmacist who provides personalized care and counseling, including providing refill reminders to “p