- When it comes to consumer engagement with a certain product, it’s all in the packaging. The same rings true in healthcare, as more medical professionals are considering dose packaging to help improve medication adherence and patient engagement in chronic disease management.
At Buffalo Pharmacies in Buffalo, New York, pharmacists use specifically grouped packaging to help patients better manage their own medications. These packages, made by pharmacy packaging company Omnicell, put pills into different blisterss depending on which pills patients should take together and the time of day at which they should be taken.
Grouping the packages together like this helps the pharmacy combat poor medication adherence, which is one of the biggest challenges in chronic disease management, according to Buffalo Pharmacies general manager Alec Gillies.
“The adherence packaging and the co-mingled packaging makes it very simple for patients to understand,” Gillies said in a recent interview with PatientEngagementHIT.com. “It's a pretty easy sell for us. Some people still like their pills, and that's fine, but to be able to have all their medications in one simple packet or pouch or blister, with the date, with the time on it couldn't make it any easier for patients.”
And while medication synchronization programs certainly have been an effective first step in getting patients more organized with their pills, adherence packaging takes everything a step further.
“Medication synchronization still doesn't make it easier for somebody to have 12 pills on a counter and understand, ‘I'm taking this one this morning and this afternoon,’” Gillies added. “It just makes it very easy for them to overlook something or to take them too many times.”
After just over two years of using these adherence packages, patients visiting Buffalo Pharmacies have significantly improved their medication adherence, a pattern that reflects most recent research, Gillies said.
A 2018 study published in Innovations in Pharmacy found that patients have both improved medication adherence and improved outcomes when they use blister packaging, or the blisters Gillies’ pharmacy uses. These blisters work to improve adherence on their own, the study found, but even better when combined with medication therapy management sessions.
Pharmacists are in the perfect position to deliver those medication therapy management services, Gillies said. While a primary care provider or chronic care specialists might only see their patients six or seven times each year, the pharmacist has more opportunities to meet with the patient.
“A pharmacy's going to tend to see that patient up to 20 times a year,” Gillies estimated. “The number of touches that pharmacy has with a patient is vastly greater than most other clinicians that a patient is going to see through a year's time.”
Most prescriptions are filled for four weeks at a time, Gillies explained, meaning the pharmacy sees the patient 13 times annually at bare minimum. But different medication needs, patient questions, or prescriptions that went a little too quickly usually bump that number up to 20.
Pharmacists often use this time to drive better patient education, a key part of improving the overall patient healthcare experience.
“Patient education is a big piece that actually aids in all other areas of engagement,” Gillies asserted. “A well-informed patient is going to be a better patient, whether it be through adherence or understanding their medication regimen compliance.”
Better patient education can improve medication adherence, overall treatment protocol adherence, and overall increased patient activation.
But pharmacists can use this time for other purposes, too, making it simpler for patients to receive care without the hurdles of visiting the doctor.
“Engagement doesn't always require somebody driving to the doctor, sitting down for a half an hour waiting to see the doctor, and then getting five minutes of time to get a question answered,” Gillies said. “These quick engagements that we can have at the counter or at the consultation area are very productive.”
For example, many pharmacists use their time with patients to check in on their chronic conditions. A pharmacist can ask an asthma patient about their control of the disease, or how often they use the rescue inhaler. If the pharmacist senses that something is off with the patient report, the pharmacist can communicate with the specialist or primary care physician to adjust the treatment plan.
At Buffalo Pharmacies, Gillies and his staff are working on improving this communication between themselves and primary care physicians. Currently, the pharmacy relies too heavily on the telephone or fax machines. A better technology interface will allow pharmacists to document a patient interaction using codes that are familiar to technologies in the doctor’s office, making communication more seamless.
Using adherence packaging has made all of these efforts easier, Gillies said. These tools not only allow patients to manage their own medications, but also allow providers to manage how the patient is taking their medication.
If a set of blisters have not been used within the four-week window, Gillies knows the patient has not been adherent and can begin interventions from there. Although he and his team know that not every patient is perfect in his adherence, the blisters do give a useful window into patient habits.
The packaging options are just one tool in Buffalo Pharmacies’ arsenal, Gillies added. After all, this strategy may not be effective for all patients.
“It's not for everybody, but it is for a lot of people,” he said. “Some of it's just patient preference, that they're completely comfortable taking their pills now. They don't want to change.”
This is not a bad thing, Gillies continued.
“Whatever works for that specific patient is what we're looking to do,” he explained. “As a pharmacy, you want to have an arsenal of solutions in your pocket to help that patient, engage with that patient, help them understand the medications they're on.”
Ultimately, efforts are centered on improving outcomes for all patients, and Gillies and his pharmacy team know that will require more than a one-size-fits-all approach. Instead, it will require patient-centricity and a careful evaluation of specific patient preferences.
“The net goal is the outcomes, and how we get there as a pharmacy,” Gillies concluded. “We approach it with several different tactics, and it's patient specific. There's new things coming out, new methodology coming out all the time to potentially help drive adherence, whether it be an app or whether it be something that's going to remind you of this. But not all tools work for everybody.”