3 Key Influencers in Improving Medication Adherence

Wednesday, January 4th, 2012
This post was written by Patricia Donovan

The big three players in programs to improve medication adherence are the primary care doctor, the pharmacist and the case manager, according to 2011 market research by the Healthcare Intelligence Network. The pharmacist is also being recruited in a big way to assist with these programs, both at the health plan and primary practice levels, according to 162 healthcare organizations that took the survey. Often it is the pharmacist in the patient’s local drugstore that is making the primary contact, frequently with the help of motivational interviewing, and the patients like this.

“The patient feedback is our secret weapon, because it does provide the patients with the opportunity to be able to say, ‘I felt I was heard and understood, my needs were met,’ explains Dr. Janice Pringle of the University of Pittsburgh School of Pharmacy. The university is a collaborator in a pilot that teaches retail pharmacists the principles of motivational interviewing, which they in turn use to screen customers for adherence issues. Other pilot participants are Rite Aid and CECity. “It’s not satisfaction,” she stresses. “A lot of people call it that. Satisfaction is more of a passive, evaluation of the process, where feedback is actually saying how they felt that their needs were met.

The University of Pittsburgh pilot participants are evaluating some of the interim results, she notes. “As a researcher, I’m very, very careful. However, I can say that there is an indication that there are statistically significant changes in adherence for the participating [pharmacy] sites. This will be borne out by our more thorough evaluation in mid-2012. We’ll be comparing not only changes over time amongst the intervention pharmacies, but also comparing to a group of pharmacies that we consider control pharmacies for the same time period and the same metrics.”

Pharmacist motivation and satisfaction with the effort is high, as well. Dr. Pringle shares a comment from one of the pharmacists in the pilot: “We have to do this project. All of us have been trained to work with patients and we have not been able to do that. This is the chance we’ve been looking for to have more contact with our patients and to make a difference in their lives.”

The prevalence of programs to monitor and improve medication adherence has remained steady from 2010 to 2011; this year’s survey identified just a slight uptick in adherence-related interventions. While the big five chronic conditions — ischemic heart disease, diabetes, COPD, asthma and heart failure — are still primary targets for these programs, there is also a move toward targeting individuals with dementia, stroke and osteoporosis.

The value of case managers in improving medication adherence levels is underscored by health plan respondents: 56 percent have given primary responsibility for these programs to case managers. Several future programs will embed case managers in physician practices for this purpose and/or step up case management of patients with chronic illness.

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