Compliance Is Declining—How Can We Help?

MAY 01, 2006
Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief

Patient compliance continues to be a major problem—one with disturbing implications. Studies confirm that large numbers of patients do not stay on their medications and that compliance declines over time.

It is no surprise that every sector of the health care industry is trying to find solutions. One such sector is the pharmaceutical industry, whose compliance programs can be controversial even when they have positive results. Pharmacy Times has explored some recent compliance initiatives and the controversy surrounding them in ePharmacy Times, our on-line newsletter, which can be found at our Web site,

As pharmacists, we should be in a good position to help with patient compliance. The regular contact between pharmacist and patient could present an ideal opportunity to discuss how a patient is doing with his or her medication.

A pharmacist's time is not inexpensive, however, and it is worth noting that many current industry efforts to manage compliance rely on comparatively low-cost methods, such as call centers. With staff shortages and shrinking reimbursements, there are plenty of more urgent matters vying for a pharmacist's attention.

Yet, pharmacist involvement can make a difference. That difference has been demonstrated by the health care project in Asheville,NC—an example of collaboration between employers, health care providers, pharmacists, and others, facilitated by financial incentives offered to patients. Pharmacists received special training and played a key role in helping patients manage diabetes more effectively. The result has been sustained improvements in compliance and patient health, and there also have been financial benefits.

From my perspective, it has been frustrating that the Asheville model has not been more widely emulated. Perhaps that situation is changing, with the establishment of similar recent initiatives, such as the American Pharmacists Association Foundation's GlaxoSmithKline-supported Diabetes Ten City Challenge.

Support from other health care players certainly makes it easier for pharmacists to play a role in patient compliance. It also could help, however, if pharmacists were more prepared to seize the initiative. It may be impossible to manage the compliance of every patient, but perhaps even busy pharmacists could find time to discuss compliance with just 5 patients. Doing so would be a start—one that indicates pharmacists' willingness to play an even larger role.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.

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