Community pharmacists can improve patients’ adherence to their medicines. But how? Shital Parikh Mars explains…
In today’s healthcare system, pharmacists play a key role in monitoring patient adherence, which means that the patient is maintaining the proper dosing schedule throughout the medication cycle as well as continuing to take a medication for as long as the treatment is necessary. More so than ever before, adherence is closely monitored with pharmacies and doctors bearing financial responsibility for ensuring patient adherence. Improvements are being made, but as of 2017, 50% of patients are still non-adherent. To address the problem, pharmacists must understand why patients are non-adherent.
Adherence is complicated because there are many reasons why a patient may fail to take a medication. Medication cost, side effects, complexity of the treatment regimen, forgetfulness, lack of motivation, lack of faith all impact a patient’s ability to stay on track with a treatment plan. Pharmacists can play a key role in improving adherence and the patient wellbeing, but to do this, they must know their patients and use their clinical expertise to achieve results.
Pharmacists are already accustomed to consulting on medication therapies, but now they must elevate the conversation to ensure that they are alleviating any obstacles that medications may present to adherence. When pharmacists evaluate patient medication profiles, in many instances, risks to patient adherence is clear. There may be duplications of therapies prescribed by multiple doctors, harmful drug interactions, or a dosing schedule that is difficult to comprehend let alone adhere to. In these cases, it’s the pharmacist’s job to work with a physician and the patient to streamline the process to make sure that the patient only has what medications they need and that those medications which will provide the healthcare results they seek. In these interactions, they can ascertain from the patient whether side effects are playing a role in non-adherence. In most cases, the solution is simply a new dosing schedule or switch from one manufacture to another of the same medication. When a medication is not well tolerated, then a pharmacist can speak to a physician about alternative drugs of the same type or side effect mitigation treatment that will alleviate discomfort and increase adherence.
It is difficult to address forgetfulness because it is human nature to forget. People live busy lives, and even the best patient can be prone to miss a dose here and there and forget to pick up medications from the pharmacy when refills are ready. But there are innovative pharmacy solutions that can help. New medication packaging machines have been specifically designed to improve adherence. They pre-sort and pre-package a patient’s medications in easy to use pouches with each pouch having just the right medications in the right doses for every time of the day when a patient needs treatment. This is particularly helpful for patients with stable multi-drug medication regimens because it eliminates guess work and allows a patient to clearly see when a medication should be taken. Missed doses are easy to see as well, as each pouch is labeled with date and time the medication was supposed to be taken.
So much of how well a patient does with a medication regimen has to with how a patient feels about the medication and not the medication itself. Patients are influenced by their upbringing and their personal philosophies can have a strong impact in how much they trust their healthcare providers. If a patient does not have the right perspective on medications, they are more likely to misuse them or avoid them completely. To help guide patients to the right understanding of what medicine can do for them, pharmacists cannot just rely on dry statistics. Rather they must endeavor to reach their patients on an emotional level. This means having meaningful conversations with patients about their life and health.
Pharmacists have more opportunities to encounter patients than their providers. They are a unifying source of information for a patient and are a valuable resource when discussing medication options. When a patient is non-adherent the evidence presents itself early and often in the form of excess medication, running out of medication early, or failing to access refills appropriately. When pharmacies encounter these symptoms of non-adherence, they must act quickly and engage. To be effective, pharmacists must speak to patients in ways that foster true understanding. They must be compelling in a way that leads to patient action. Diversity of staff can help with this because patients are more likely to trust a pharmacy that they feel understands where they come from and how they feel. Encouraging diversity of thought amongst technicians, delivery staff, cashiers, and pharmacists will not only increase patient loyalty but increase patient adherence as well.
There is so much pharmacists can do to improve adherence among patients. Even though the world is moving to a patient driven healthcare system, pharmacists can and must play a vital role in helping patients navigate a complex health structure that leads to even more complex medication therapies. Patients are ill-equipped to heal themselves, so pharmacists should support their patients with the right tools, clinical expertise, and personal care that will lead to adherence and long term wellbeing.