Medication Adherence: Getting Patients' Buy-in
Author: Fred M. Eckel, RPh, MS, ScD (Hon), Pharmacy Times Editor-in-Chief
Medication synchronization programs have been promoted as an important tool to improve medication adherence.
More than ever, medication adherence is a focal point in health care today as the landscape evolves. Recently, I was invited to be a panelist on “Recognizing the Importance of the Pharmacist’s Role: Making Greater Strides Towards Increased Adherence” as part of a 2-day program, with many attendees coming from the pharmaceutical industry. There is no doubt in my mind that people are paying more and more attention to medication adherence.
Medication adherence is a challenge for many health care stakeholders, and the pharmacist is a key player to accomplish improved medication adherence. Patients have the opportunity to interact with pharmacists frequently. Those interactions have the potential to be very qualitative because pharmacists know the patient and their family. Pharmacists also frequently know the prescriber, and they are the drug product experts. Today, pharmacy practice models are changing to give the pharmacist time to have more direct patient interaction.
Although all of this is true, unless the pharmacist recognizes that a medication adherence problem exists with a particular patient, the frequent pharmacist–patient interactions may not lead to improved adherence. A focused intervention is required—with regular reinforcement—to achieve mutually agreed upon adherence goals. Experts agree that many reasons exist for medication nonadherence. Therefore, no single program will work in all situations.
Many studies have demonstrated that the lack of medication adherence is a major driver of health care cost. Nonadherence costs more than $100 billion a year. More than 50% of patients don’t take their chronic disease medications as prescribed. Thirty-three percent of first-time prescriptions are never filled. That is why increased attention is being focused on improving medication adherence.
Perhaps health plans should focus more attention on how well their patients adhere to their medication regimen. The Centers for Medicare & Medicaid Services (CMS) might consider making medication adherence and appropriate medication use part of its Quality Rating System for Qualified Health Plans, as suggested in a letter that the National Association of Chain Drug Stores recently sent to the CMS. Medication therapy management (MTM) programs encompass more than just medication adherence assessment, but assessment is a component. As payment for MTM increases, medication adherence should improve.
Recently, medication synchronization programs have been promoted as an important tool to improve medication adherence. When patients are taking several medications, making sure that all medications can be refilled at the same time is certainly more convenient for the patient. Studies have shown that it is also more efficient for the pharmacy. It requires that the payer allow a partial fill in order to keep refills on schedule. More payers now recognize the benefit of synchronization and are willing to cooperate in this effort.
The National Community Pharmacists Association recently reported the results of a study conducted with Ateb, Inc, involving more than 1300 patients enrolled in a synchronization program at 10 independent community pharmacies across the country. They reported that patients who opt in to medication synchronization programs offered through their community pharmacy average more than 100 additional days on therapy per year and are 30% more likely to take their medication as prescribed than patients not enrolled in a synchronization program.
Examples like this are why I started this commentary by suggesting that the pharmacist is a critical player in promoting medication adherence. The key to successful medication outcomes is being sure that a patient is receiving the correct medication, so MTM should be a part of any adherence program. Patients need to participate in these programs, and successful programs require real patient buy-in.
As you interact with the patient, ask open-ended questions that may help determine how well a patient is complying. Take the time to make sure your patients are educated about their disease and its treatment, especially when they receive a new prescription. Many tools are available to help patients remember to take their medicines. Recommend a tool if appropriate. If your pharmacy does not focus on patient medication adherence yet, I suggest you make it a goal for this year. More pharmacists are making this a focus in their pharmacies, and you don’t want to be left behind.
Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is emeritus executive director of the North Carolina Association of Pharmacists.