One single behavior can have a profound impact on patient health – and that’s medication adherence. Medication adherence is defined generally as taking a prescription medication correctly as prescribed. When managing chronic conditions, such as hypertension and diabetes, patients do not take medications properly 50 per cent of the time, which increases the possibility of complications and worsening health.
Take hypertension alone. A U.S. study found an improvement in adherence would result in a decrease of almost 118,000 visits to emergency rooms and more than seven million fewer inpatient hospital stays annually.
In 2021, an estimated 4.69 billion prescriptions were written in the United States. Unfortunately, about one-quarter of new prescriptions are never filled. And most patients who decide to not take their medication or forego filling a prescription won’t tell their doctor. The consequences are alarming. Annually, non-adherence is thought to be responsible for at least 100,000 deaths, 10 per cent of hospitalizations and more than $500 billion in preventable healthcare costs.
Collaborating with pharmacists for better results
This underscores the important and unique role pharmacists can play in helping patients manage their health by taking medications as prescribed. Pharmacists can spot issues before they become more serious. “A pharmacist in a community pharmacy setting has direct interaction with patients,” explains Jerry Liliestedt, vice president of operations, Absolute Pharmacy, Inc. in North Canton, Ohio. “Oftentimes, simply by having a conversation and asking the right question, you’ll learn they aren’t taking their medication due to side effects they’re experiencing or cost of the medication. Sometimes, you may notice a patient isn’t requesting refills. Those are signs that non-adherence is occurring.”
From there, there’s an opportunity for pharmacists to have discussions about obstacles to adherence and what it means to a patient’s health. Medications aren’t taken as prescribed for many reasons. Cost and side effects are common ones, but there are other obstacles. “Some people don’t understand the serious nature of adhering to medication and taking it at the same time every day as prescribed,” says Liliestedt, who has been a pharmacist for nearly 25 years. “Maybe it’s because they didn’t have a chance to talk with their physician when the drug was being prescribed. That may mean a patient walks out of the office with a prescription that they’re not comfortable with or not fully informed on what they should be doing with it.”
Pharmacists have a lot more touchpoints with a patient seeing them every month or every couple of months as they’re ideally refilling those medications, he notes. Meanwhile, they may see their physicians once or twice a year. “A pharmacist has a unique opportunity to really get involved and intervene if they see a patient is having a problem,” he says. He suggests pharmacists take the time to find out a patient’s level of knowledge and understanding about what drugs they’ve been prescribed and why.
When managing chronic conditions… patients do not take medications properly 50 per cent of the time, which increases the possibility of complications and worsening health.
For some people who are taking multiple prescription medications, adherence is even more challenging. A data brief from the National Center for Health Statistics shows more than one adult in five between the ages of 40 and 79 uses at least five prescription drugs. In an older population (ages 60 to 79), that figure jumps to almost 34 per cent. “If a patient has to self-administer or manage those medications themselves, the more potential there is for errors, non-compliance and non-adherence,” he says. “In the U.S., most medications are still dispensed in your vials with lids. People end up with 10 or 15 bottles of pills. And then they’ve got to sort out what to take when.”
Smart tools available to help patients
To improve medication adherence, a number of tools are available, from mailing educational materials to clinic-based intervention.
“There are a lot of options,” explains Liliestedt. “Anywhere from simple, seven-day or 28-day pill containers that can be provided to a patient to sophisticated technology that ties into the Internet.” He also talks about adherence packaging, such as multi-dose blister cards that can help patients take the right pills at the right time, whether it’s with meals, in the morning or evening, by grouping medications together in a convenient format. It is used widely in the nursing homes and assisted living facilities with which his pharmacy works. It helps nurses be more efficient with dispensing. When patients are released and return to their homes, they leave with medications in medication adherence packaging to ensure they stay on track.
Findings from a 2021 study examined the impact of medication adherence packaging service on patient-centered outcomes at an independent community pharmacy located in Pittsburgh, Pennsylvania. It saw 88 per cent of participants missing fewer doses compared to the period before using medication adherence packaging. Furthermore, 86 per cent felt more confident about taking their medications and 74 per cent experienced greater independence.
pharmacists Play an important ROLE in helping patients manage their health by taking medications as prescribed. they can spot issues before they become more serious.
While medication adherence packaging is well known in Canada and Europe, it is lesser-known in the U.S., but is slowly catching on. Liliestedt feels that the uptake could go more quickly with government intervention or third-party payers and insurance companies recognizing that there are potential savings if people were healthier and not going back into the hospital.
“If we get them to incentivize the packaging, then it would be a gamechanger, but we just haven’t gotten to that point yet,” he says. “I think adopting adherence packaging would be better for everyone. I’m a big believer in it. There’s no doubt.”
Produced with support from Jones Healthcare Group.