- Low rates of medication adherence has brought the importance of supporting patient engagement in the pharmacy to the forefront. As patients continue to struggle to stick to treatment plans, clinicians assume most of the responsibility of motivating patients to follow a specific drug regimen.
Doctors, nurses, and other clinical professionals play a big role in improving medication adherence, working to uncover the barriers patients face in accessing their medications. But clinicians are not the only stakeholders supporting patient engagement in the pharmacy.
Patient engagement and medication adherence hinge on the teamwork of providers, pharmacists, and pharmaceutical companies to ensure patient engagement strategies are fully patient-centric.
Clinicians drive education for medication adherence
Clinicians take on patient medication education in an effort to improve medication adherence. Patients need adequate information to safely take their medications and to understand the importance of taking medications regularly and properly.
Clinicians must take a few considerations in driving patient education and medication adherence. Patients will require a varying amount of education and some language assistance.
Clinicians should also engage the family. Patients must absorb a great deal of information, especially when facing a new chronic diagnosis. Educating a family member about medication directions increases the likelihood that the patient will have adequate medication instruction.
Patient medication education efforts should be informed by patients and families, according to Rod Tarrago, MD, Associate Chief Medical Information Officer and Medical Director of Medication Safety at Seattle Children’s Hospital.
After learning that the hospital’s previous medication education strategies fell short, Tarrago and his team created a new system that served patient needs.
“We’d gotten a lot of feedback from our patients and families that the documents they received upon discharge were a little bit lacking,” Tarrago said, suggesting a lack of sufficient education provided as part of their existing patient medication safety program.
Tarrago and his team previously made medication lists for patients. When those lists were accurate, they worked modestly well, Tarrago said. But usually those lists were littered with inaccuracies, and the layout was not effective for patients and families.
Tarrago and his team adopted a tool called Meducation, which offered a calendar format for scheduling medications. The digital tool also contained medication instructions in 22 different languages that patients could access at any time.
While the hospital still has room to grow — Tarrago said he wants to adjust the tool to work for patients with one to 30 different medications — he said their success came from making education patient-centered.
“It really is about learning from each other and keeping patients at the center,” Tarrago said. “Historically, medication reconciliation has been fragmented. In the end, it’s about making sure the patient is taking the right medicine, at the right time, for the right disease.”
Part of designing patient-centered medication systems is understanding the individual barriers patients face to taking their medications. In adult populations, those barriers can range from drug affordability to remembering to take the drug.
For pediatric patients, those barriers include pill palatability to motivation to take medications.
At Cincinnati Children’s Hospital, clinicians use an EHR-embedded tool to aggregate medication adherence data, patient demographic information, and survey-informed adherence barriers. Providers use this information to create medication adherence strategies alongside their patients.
In particular, this tool helps with the hospital’s kidney transplant population where non-adherent patients run the risk of rejecting their transplant. Using patient information and shared decision-making, providers empower patients to take control of and manage their medications.
“This is really focused on partnering with patients,” said David Hooper MD, MS, Medical Director of Kidney Transplantation. “Once they feel like we’re the enforcers, it sort of falls apart. It is an important culture that we’re trying to establish that we’re all partners in this. This is about identifying things that are getting in the way of taking medicine rather than assigning blame.”
Clinicians need to ensure that their education strategies center on patient needs. In doing so, they increase the likelihood that patients will adhere to their medication plans and understand the importance of doing so.
Pharmacists build lasting patient-pharmacist relationships
Pharmacists can improve patient medication adherence and drive better patient education by creating lasting relationships with these patients.
Creating medication therapy management (MTM) programs gives pharmacists the time necessary to forge deeper connections with patients, according to Chuck Riepenhoff, a clinical pharmacist and diabetes coach. MTM programs use longer coaching periods to help identify the root issues to medication adherence.
“Instead of only being able to spend 45 or 60 seconds with the patient talking about the basic things, in these MTM programs we’re sitting there talking to that patient for 45 to 60 minutes,” explained Riepenhoff, who practices at The Pharmacy Counter, a ProMedica pharmacy. “When you spend that much time talking to the patient, you’re finding out a lot more details, some very valuable information.”
Riepenhoff uses health data analytics to keep track of patients who are not adhering to their medication plans, he said in a previous interview. Data can reveal patients who do not fill a certain drug every month, who do not take different drugs each month, or who regularly miss multiple drugs or skip doses.
Having this knowledge about the patient and understanding the patient’s personality helps Riepenhoff determine which medication strategies to enlist. Medication synchronization might be effective for the complex patient with multiple medications, he suggested. This helps the patient fill all of her pills on the same day each month.
Patients who have trouble staying organized might benefit from pill boxes or other alternative pill packaging systems, he said. Riepenhoff also works with patients to create organizational strategies within the house, such as leaving sticky notes in key areas or setting timers to remind patients to take medications.
Riepenhoff is able to determine these strategies by building a strong relationship with the patient, he said.
“The value of a community pharmacist is no doubt filling the prescription and making sure the prescription we’re filling is the right med at the right dose, and that there are no negative potential drug interactions,” Riepenhoff noted. “But we are also able to give that patient some very valuable information to take home with them about their medication.”
Not all pharmacists are given the opportunity to spend nearly an hour with patients — most spend mere minutes with patients. In these cases, pharmacists may not be able to dig deeply into a patient’s personal life, but they can pick up on the bigger issues necessary to target patient engagement strategies.
Pharmacists should always educate patients about medication safety and dosage protocol. Providers should discuss these topics in laymen’s terms, and ask patients to explain the instructions back to assess patient understanding.
Pharmacists can also take a moment to ask potentially high-risk patients — ones with complex regimens, or who have not filled a prescription in a while — about their organization habits, which could signal red flags for pharmacists and alert them to patients who may not remain adherent to a drug.
Pharmaceuticals develop patient-centered services
Patient engagement does not start and end with the clinician or pharmacist, and pharmaceutical and drug companies are increasingly aware of that fact. Drug manufacturers are starting to incorporate patient-centeredness into their own strategies and creating more patient-facing services.
A 2016 Accenture survey showed that 91 percent of pharmaceutical companies planned on incorporating at least six patient-facing services by 2018. Some potential services include benefit coverage and access services, adherence program management, remote patient monitoring, medication delivery and support, and patient outreach, reminders, and drug scheduling.
These efforts are thwarted by a lack of patient awareness of engagement services. The survey showed that only 19 percent of patients know about patient-facing pharmaceutical services, potentially because doctors do not discuss services with their patients. Eighty-one percent of pharma companies rely on doctors to discuss services with patients.
Another Accenture survey from 2017 found that doctors themselves are not fully aware of patient-centered pharma services, barring doctors from informing patients about the services.
This dichotomy reveals a major area for improvement, according to Accenture Managing Director of North American Intelligent Patient Services Tony Romito.
If pharmaceutical representatives and clinicians expand their lines of communication, both parties can create a better understanding regarding patient-facing pharma services. In turn, patients have better resources to learn about the tools available to them through their pharmaceutical providers.
“Our previous research revealed patients want, value and expect patient services from pharmaceutical companies,” Accenture Managing Director of North American Intelligent Patient Services Tony Romito said in a statement. “The fact that pharmaceutical companies’ main conduit for this information — healthcare practitioners — aren’t very aware of these services presents a significant opportunity.”
“The industry can improve the impact they are having with patients if they can more effectively engage healthcare professionals around the availability and benefits of their support programs,” Romito added.
Going forward, the duty of supporting patient engagement in the pharmacy will not rest with one single stakeholder. While clinicians and pharmacists work with individual patients to motivate patients to adhere to treatment plans, pharmaceutical companies must continue to deliver products patients want to use.
The symbiotic relationship will continue as pharmaceutical companies inform clinicians and pharmacists of these offerings, and those clinicians educate patients about the different services. These three stakeholders must cooperate to create patient-centric medication offerings, ensure patients know about those services, and adhere to those services.