Medication non-adherence is a significant population health issue, with a price tag totaling millions of dollars per year in avoidable costs.
When confronting the issue, healthcare professionals don’t just face the challenges of creating better prescription and pharmacy protocols, but also of accounting for potentially uncontrollable patient behavior.
The task may seem daunting, but through better prescription management, providers will be able to generate better patient engagement and reduce non-adherence rates. Using this series of patient-centered steps, pharmacists and providers may be able to ensure that patients understand the importance of taking their medications as prescribed.
Identify the causes of medication non-adherence
Medication non-adherence is a complex issue that is deeply rooted in patient behavior. Although there is no set formula for determining which patients will remain adherent to their medications and treatment plans, there are some qualities that may indicate a tendency toward medication non-adherence.
In an Express Scripts white paper released last year, experts said that 69 percent of medication non-adherence boils down to patient behaviors. By identifying telltale behaviors, pharmacists and other healthcare professionals can better intervene and ensure patients stick to their treatments.
Common predictors of non-adherence include procrastination, forgetfulness, or confusion caused by multiple medications.
Although the last of those predictors may be mitigated through specific medication protocols, it is near impossible to know whether a patient is forgetful or prone to procrastination without knowing them on at least a moderately personal level. This is where it is important for providers to engage their patient outside of the doctor’s office.
According to Mark Wagar, president of Heritage Medical Systems, it is the extra engagement that makes all the difference in clinical outcomes.
“It’s in fact as important, if not more important, to be able to figure out how to work with them to improve their general health status so that they have fewer events where they fall in the door,” Wagar said in a recent interview with PatientEngagementHIT.com.
Getting to know patients outside of the scope of care will help pharmacists and providers better understand their patients. Those professionals will then be able to shift their medication non-adherence strategies from reactive to proactive, helping patients stay adherent rather than mitigating when they become non-adherent.
Create an action plan
Pharmacist groups have worked to develop new protocols to administer prescription medications to help patients avoid medication non-adherence, includingmedication synchronization.
Medication synchronization consists of pharmacists aligning prescription fills to occur all on the same day. This is particularly helpful for patients managing chronic illnesses that may require multiple medications.
Research shows that these approaches are effective. A study conducted late last year by the National Community Pharmacists Association (NCPA) and the Arkansas Pharmacist Association showed that patients enrolled in medication synchronization programs were 2.57 times more likely to remain adherent.
Medication synchronization is also effective in prolonging the transition from adherent to non-adherent. The researchers found that those not in a program stopped taking their medications between 145 and 182 days into the study, while those who were in the program and stopped taking their medications did so between 181 and 222 days into the study.
These findings were consistent with other industry findings, the researchers explained.
“These findings have previously been shown in individual pharmacies and most recently in a large study of 71 members of a regional community pharmacy chain,” the authors noted. “This study demonstrates that similar results can be obtained through a large, virtual network of independent pharmacies operating on multiple PMSs.”
Use efficient approaches to forge relationships with patients
Despite the numerous reports of the effectiveness of medication synchronization, researchers maintain that robust patient engagement is vital in preventing medication non-adherence.
A recent study published in the American Journal of Managed Care shows that although medication synchronization programs have been established at a great number of pharmacies across the country, their successes may be to the credit of other factors, namely patient engagement.
“Although synchronization programs have proliferated in the last 2 years, evidence regarding improvements in patient-centered outcomes remains sparse,” the research team reported. “[N]one of the studies we identified through an extensive systematic review process robustly accounted for the fact that patients choosing to enroll in a synchronization program may be very measurably different from the general population, and that enrollment may lead to behavior changes that are independent of the program mechanism itself.”
Factors independent of the program itself included more consultations with pharmacists and better explanations of treatment plans.
Experts say providers should take advantage of the extra time they may have due to the efficiency of medication synchronization programs. According to the NCPA study, these consistent meetings between patient and pharmacist are an ideal time for increased patient engagement.
“By simplifying the pharmacy’s workflow, the pharmacist has more time for valuable patient interactions and other services that help improve health outcomes,” the NCPA study stated. “Patients’ personal connection with a pharmacist or pharmacy staff is the number one predictor of medication adherence.”
Providers need to recognize that although prescription protocols are an important factor in improving medication non-adherence, they are not the whole picture. Supplementing these strategies with effective patient engagement strategies will be important as the healthcare industry bears focus on population health and chronic disease management.