The estimated annual cost of prescription drug-related morbidity and mortality resulting from non-optimized medication therapy has been estimated at more than $500 billion, per Pharmacy Times, with more than 275,000 deaths related to non-optimized drug therapy occurring every year.
The Challenges of Medication Adherence
Medication adherence is one of the most difficult challenges faced by community pharmacists. There are many reasons patients do not or cannot comply with their medication schedules, and pharmacists are their main line of defense and communication to fight against adverse outcomes.
One of the most impactful things a community pharmacy can do is create a medication adherence program to assist patients in understanding and complying with their medication regimens. Adherence not only reduces morbidity but can significantly lower costs of patient care and improve public health, according to the Centers for Disease Control and Prevention.
What is a medication adherence program?
A medication adherence program is a method of helping educate, inform and motivate patients in relation to their medication schedule(s). Since patient compliance is one of the biggest variables in patient outcomes, being able to help individuals appropriately manage their medications is key to preventing unnecessary hospital visits, complications of chronic conditions, or even death.
Who needs help with medication adherence?
Anyone who struggles with medication schedule compliance is a good candidate for a medication adherence program. This can include:
- An elderly patient who may forget to take a prescription medication
- Anyone with a chronic condition like diabetes
- Someone who is on multiple medications
Managing elderly patients with chronic conditions and/or multiple medications
The intersection of these patient populations is where the most risk lies if medication adherence is not achieved. Community pharmacists, particularly in rural areas, often have many such patients turning to them for help and are ideally situated to help manage patient care through a medication adherence program.
Why do patients fail at medication adherence?
The National Community Pharmacists Association noted in their highly publicized “Medical Adherence Report Card” that patients most likely to be non-compliant with their medication regimen were those who lacked a strong relationship with their pharmacist. Their survey revealed that one out of three patients over 40 with a chronic condition rated a D or an F when it came to taking their medications correctly.
There are many reasons a patient may be non-compliant with their medication regimen:
- Forgetfulness due to age or dementia
- Multiple medications with confusing or contraindicatory instructions
- Medications that make the patient feel temporarily worse
- Medications which have side effects that are not well tolerated by the patient
- Costly medications that are difficult or impossible for the patient to afford
- Lack of transportation to get to a pharmacy regularly to pick up refills
- Patient is not properly educated on his or her medication
A medication adherence program can help to address all these obstacles and assist patients in reaching adherence.
How a Medication Adherence Program Works
A medication adherence program is centered around patient education, proactive counseling, and overall synchronization, with the goal of optimizing medication use by patients and reducing medication overuse or underuse.
What are the dangers of medication nonadherence?
Medication non-adherence can lead to uncontrolled chronic conditions leading to complications, worsening of a medical condition, inaccuracies in dosing, and even death through overdose or non-treatment of a critical condition.
For example:
- Diabetics who fail to control their blood sugar can suffer from irreversible vision damage
- Heart patients who fail to follow their medication regimen can suffer a cardiac event
- Patients with multiple medications may find they are ineffective when taken at the wrong time
Healthcare, patient, and medication synchronization
Working with each patient on a regular basis to review medications and suggest ways to increase adherence can reduce unwanted outcomes. A community pharmacy can work with doctors and patients to help streamline care and synchronize medications to improve compliance.
Pharmacists can help coordinate a patient’s medications to provide single-dose medications that contain multiple prescriptions, instructions on how to utilize a smartphone app to provide reminders, packaging to facilitate easy real-time guidance for daily medications, and medication delivery to cut down on repeated pharmacy visits.
Medication Adherence Program Administration
Medication adherence programs can be set up and run by a variety of institutions, including hospitals. However, Pharmacy Today states that patients typically see their pharmacist two to seven times as frequently as they do their primary care physician, positioning pharmacists to be the prime contact for such a program.
Community pharmacy involvement in patient adherence
Community pharmacists are the ideal administrators of medication adherence programs because they are most likely to be filling all prescriptions for any given patient.
They may even have a clearer picture of a patient's overall medication profile than a prescribing physician, particularly if the patient has been seen in an emergency or urgent care setting and may not have provided their full medical history or medication list at the time of treatment.
Pharmacists can catch potential drug interactions or other problematic contraindications based on their knowledge of the patient and provide a safety net. They are also typically trusted by patients to make recommendations and offer guidance about medication dosing.
Patients enrolled in Medicare Advantage or Part D plans may specifically be eligible for medication adherence programs. Participation and improved adherence can improve ratings for the plan and increase eligibility for incentive payments by improving patient quality of care scores.
Benefits of a Medication Adherence Program
Improving patient care and clinical outcomes through improved medication adherence is an achievable goal. Community pharmacies can make medication adherence a cornerstone of their practice, improving clinical outcomes and reducing patient health care costs through tighter chronic disease control.
Improving patient outcomes and reducing health care costs
Medication adherence programs are the best way to control chronic conditions. Two of the most common diseases that suffer from medication nonadherence and respond favorably to medication adherence programs are diabetes and hypertension.
Both conditions are highly treatable with oral medications as the first line of defense, but patient nonadherence causes a raft of issues and complications. Uncontrolled diabetes can lead to neuropathy, improper wound healing, diabetic retinopathy, and risk of heart attack or stroke.
By improving patient adherence, community pharmacists can help reduce the risk of such complications, enhance overall patient health, and deliver improved patient outcomes. This in turn can significantly reduce health care costs for at-risk patient populations.
Implementing a Medication Adherence Program
Improving medication adherence is a process, not a turn-key fix. However, medication adherence solutions, like AideRx, are designed to achieve meaningful improvement in high-risk patient adherence. These interventions are driven by smart analytics to help patients overcome barriers and successfully fill their medications then take them as directed.
Pharmacists can benefit from numerous telehealth and in-pharmacy workflow solutions from TDS, which can target at-risk patient populations and positively impact specific program goals. An optimized pharmacy management system and clinical call center support enable community pharmacies to start a medication adherence program without investing a great deal upfront.
Patients need their pharmacist to be their advocate and their counselor, assisting them to achieve a better understanding of their various medications and become adherent to the prescribed regimen.
