Marty Burstein

Nonadherence to medication presents a major obstacle to the achievement of positive patient outcomes. A 2008 Medco Health Solutions Inc report noted that 51% of insured Americans were taking at least 1 medication for a chronic condition, but that as many as half of patients do not take the medications as prescribed according to some estimates.

 In 2009, the Network for Excellence in Health Innovation cited poor adherence as one of the “drug-related problems” responsible for up to 13% of total health care expenditures, or $290 billion annually in unnecessary costs.

Medication adherence can best be defined as a patient taking their medications according to the prescribed dosage, time, frequency, and direction.

 It is an effective way to manage chronic conditions such as high blood pressure, diabetes, and high cholesterol. Poor medication adherence increases the likelihood of preventable disease progression, increased unnecessary hospitalizations, avoidable doctor and emergency department visits, and other problems—and this, in turn, can lead to increased health care costs.

 A growing body of evidence suggests that medication adherence programs have the potential to greatly reduce health spending and generate significant savings for taxpayers in the process.

There are many reasons why patients do not adhere to their medication schedules. Some patients face financial barriers, while others are troubled by their medication’s side effects. A patient with cognitive impairment may not understand why or how to take their medication, while a visually impaired patient may have difficulty reading the small print on medication bottles. An individual might not have close family members to help monitor and give the medications properly. No matter what its cause, prescription nonadherence is a real problem. Doctors, hospitals, and other medical professionals are working to solve this problem with tools and programs that educate, alert, remind, and encourage patients to stay on track with their medications.

MedPack Pharmacy, based in New York City, has seen positive results for compliance with the use of its patient adherence strip-system (PASS) packaging. A simple alternative to cumbersome medication planners and bulky blister packs, PASS organizes medications and OTC oral solids by day and dose time in a clear cellophane pouch. Each packet is labeled with the patient’s name, day of the week, date, time of dose, and drug information.

PASS packaging facilitates medication therapy management (MTM) and compliance, and promotes conversation between the pharmacy and a patient’s care team. For example, a Palm Springs, California, hospital pharmacy using the PASS system as a cornerstone of its medication adherence program for congestive heart failure patients reported adherence rates over 95%, dramatic improvements in patients’ health outcomes, and reduced hospital readmissions.

Without the PASS packaging, caregivers and patients can spend about 1 hour a week preparing their weekly medications. The old method of filling the weekly pill boxes can lead to errors like double-dosing and taking the wrong pill at the wrong time on the wrong day. PASS automates the preparation of single-unit and multi-dose strip packaging, with prescriptions filled automatically by a software system within the machine. The medications are stored within the machine; models can store up to 500 medications at any time.

MedPack Pharmacy services hospitals, nursing homes, home care agencies, managed long-term care plans, and doctors-on-call organizations, and offers a program that serves the specialty medication needs of summer camps, including those for campers with special needs. This reduces the stress of camp nurses and doctors who must dispense medications to hundreds of campers.

PASS packaging has also been effective for geriatric patients in the home-care setting. Upon discharge, a patient is often given multiple prescriptions to take home and fill at the local pharmacy. It may take several days for a home-care nurse to visit and maybe another day or two before an attendant can be sent. In the meantime, the prescriptions may sit in a drawer for a few days waiting to be filled, which could lead to fluctuations in the patient’s condition. MedPack Pharmacy has been working with hospitals and rehabilitation centers to have patients’ prescriptions filled a day before discharge and to deliver the specialized medication packaging to the facility. The patient can then go home with the medications in hand.

With the PASS system, medications come in a strip filled from 1 to 28 days, and each packet on the strip reminds the patient or caregiver of the day, date, and time to take the medications. For convenience, the time of day is listed as breakfast, lunch, or dinner, or variants of those times. Clearly labeled packaging can be an aid to patients who may be forgetful or confused; one can look at the next packet on the strip to confirm that a medication dose was taken.

Since PASS packaging encourages compliance, it can help reduce hospital readmissions. This is an area of particular concern today, as the Centers for Medicare & Medicaid Services is now penalizing hospitals and adjusting their reimbursement rates based on their readmissions rates.

There are patient populations for whom medication adherence is a matter of life or death. Patients with HIV, hepatitis C, or a heart condition are examples of individuals who must be compliant with their medications or risk fatal results. In addition, many patients visit family and friends. Compliance packaging can make it easier for them to have their proper medications readily available, preventing the need to travel with multiple pill bottles.

In long-term care and assisted living settings, nursing homes, and hospitals, PASS packaging can make medication administration faster and safer and help to prevent potential medication errors caused by interruptions and distractions during medication dispensing. Each step in the PASS process enforces safety. As an additional safeguard, barcodes can be printed on pouches for bedside scanning. During replenishment, this barcode scanning confirms a match between the drug and canister. MedPack’s smart canisters communicate with PASS so that the computer always recognizes and dispenses from the correct canister, regardless of its location in the unit. If any intervention is needed while the PASS machine is packaging, it will pause until the issue is resolved.

MTM is designed to improve collaboration among pharmacists, physicians, and other health care professionals; enhance communication between patients and their health care team; and optimize medication use for improved patient outcomes. MTM services empower patients to take an active role in managing their medications. The services, however, depend on pharmacists collaborating with physicians and other health care professionals to optimize medication use. MedPack has been actively working with doctors and patients to optimize this collaboration. By using the MedPack PASS system, patients and their caregivers are more in tune with medication regimens. All of a patient’s medications are in 1 box in 1 place when strip packaging is used, in contrast with pill bottles, which could be spread out on the kitchen counter or stuffed into a drawer. The medication packet can be placed where it is easily accessible to the patient (eg, the dinner or bedtime packet can be put on a night table). During a medical appointment, a quick glance at the PASS packets will tell the doctor all he needs to know about the medication regimen, since all the medications are listed on every packet. This method of medication management helps patients achieve positive results.

Medicaid, Medicare, and many private insurers are investing billions of dollars to find ways to save money. Reimbursements to doctors, hospitals, and other medical professionals have been cut to the bone. Health care professionals are looking for ways to keep patients safe at home and reduce hospital readmissions. The MedPack PASS system of medication management is a very important tool in that battle. Marty Burstein is the education outreach manager of the patient relations department at MedPack Pharmacy, which uses PASS (Patient Adherence Strip-system Packaging) to promote medication compliance. MedPack is located in New York City and services areas across the United States, working closely with hospitals, nursing homes, doctors-on-call organizations, special needs facilities, HIV and hepatitis C clinics, home care agencies, and the general public.

Marty Burstein is the education outreach manager of the patient relations department at MedPack Pharmacy, which uses PASS (Patient Adherence Strip-system Packaging) to promote medication compliance. MedPack is located in New York City and services areas across the United States, working closely with hospitals, nursing homes, doctors-on-call organizations, special needs facilities, HIV and hepatitis C clinics, home care agencies, and the general public.

		Traynor K. Poor medication adherence remains a problem. American Society of Health-System Pharmacists website. www.ashp.org/menu/News/PharmacyNews/NewsArticle.aspx?id=3798. Published November 1, 2012.

		Osterberg L, Blaschke T. Adherence to medication. 

		New England Healthcare Institute. Thinking outside the pillbox: a system-wide approach to improving patient medication adherence for chronic disease. The Network for Excellence in Health Innovation website. www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf. Published August 2009.

		Medication adherence: a $300-billion problem: solutions needed to improve health and lower costs. Prescriptions for a Healthy America website. http://adhereforhealth.org/who-we-are/medication-adherence/.

		Heller A. Compliance packaging lessens adherence gamble. Pharmacy Practice News website. www.pharmacypracticenews.com. Published February 2015.

Articles

Nonadherence to medication presents a major obstacle to the achievement of positive patient outcomes. 