Despite numerous studies evaluating interventions to improve medication adherence and frameworks to understand barriers to adherence, approximately 50% of Americans are considered nonadherent to their chronic medication regimens. This can be because they are not taking their medications at all or are taking them at doses and/or times that are not recommended by their healthcare team. Either way, this is a critical issue that contributes to poor health outcomes and unnecessary healthcare expenditures.
Pharmacists can play a critical role in helping patients with medication adherence because they have a unique role in interacting with healthcare systems, insurers, and patients.
Factors that affect adherence include:
- Social and economic issues (unemployment, social support, needs for housing/food)
- Healthcare issues (multiple healthcare providers, insurance coverage)
- Condition-related issues (symptom severity, impact on quality of life)
- Therapy-related issues (perceived benefits/risks)
- Patient-related issues (knowledge, beliefs)
Understanding how these factors play a role is a key to assisting a patient to optimal adherence. Even if barriers are identified and addressed, they might change from refill to refill.
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So, what can we do as the pharmacist? Taking the time to speak with the patient on a regular basis can allow us to learn about the patient’s situation and what could be done to address adherence barriers. By learning more about the individual patient, the pharmacist can anticipate potential medication issues and then discuss a plan with the patient. For example, if side effects develop, educating the patient about other treatment options or ways to mitigate side effects can alleviate their concerns. Educating the patient about the need to notify providers about any side effect before the next scheduled visit is important as well. Although this might seem like common sense to healthcare providers, many patients just stop their medication until the next visit, and it might be months between visits. By stressing the importance of open communication with their healthcare provider, this lapse in therapy can be prevented.
Whatever the barrier may be, it is important to note that continual assessment of adherence is necessary because the factors affecting the patient can frequently change. It is prudent to assess if new factors affecting medication adherence have arisen at each visit, and if therapeutic goals have changed.
Working with health insurers on behalf of the patient is another way to facilitate adherence. Although insurers often have rules on prior authorization, quantity limits, and such, discussing patient-specific situations with the insurer can help allow for exceptions. In some cases, pharmacists can justify payment for adherence services by collecting data on patient satisfaction, improvements in prescription claims-measured adherence, and impact on retail and prescription refill sales.
Pharmacists can offer patients tools to assist with adherence as well. Several medication apps are available. Calendars and notebooks have been used for decades. Newer methods such as smart vials, tablets with electronic tracking, rewards for filling refills on time, and texts from the healthcare team are all being evaluated, but none has proven successful in all settings. Thus, the pharmacist who can holistically assess these factors might be the most well suited to facilitate medication adherence. Take the opportunity to talk with your patients. You are uniquely positioned to make a real difference.