Adherence. New word to pharmacists? New word to patients? New role for pharmacists? New role for patients? For the act of medication adherence to be successful, the patient must embrace a I'm Helping Myself ® posture regarding their health.
Webster's New Collegiate Dictionary includes several definitions of the word adhere, the act of adherence and even a name given to one that adheres...adherent (noun). As the act of adherence is about being consistent, giving support and maintaining loyalty, both pharmacists (an adherent) and their patients (an adherent) will need engage more extensively... co-join if you will... to effect success in the patient's medication adherence.
Enhanced pharmacist efforts to improve adherence has been in place for several years following a report (2007) by the National Council on Patient Information and Education (NCPIE) calling for a "national mobilization" to assist with reduction in overall national health expenditures. The most recent, latest national action agenda brought forth by NCPIE has focused on accelerating progress in prescription medication adherence through use of a concerted wider scope effort by pharmacists.
This latest action plan, the Adherence Action Agenda, contains ten policy or programmatic solutions to improve medication adherence particularly for older patients with higher rates of multiple chronic conditions. As indicated in this last report (October, 2013), up to 93.5 million patients do not take drugs as prescribed, 20¬-30% of prescriptions are never filled by patients and 50-60% of medications taken to treat chronic disease are not taken as prescribed. The "bottom line"...approximately 125,000 preventable deaths a year with $105 billion wasted annually on medication therapy non-adherence ($72.5 billion is spent on hospitalizations alone...some 69%).
Many of the suggested focus areas for pharmacists in community settings and outpatient hospital pharmacy are already being implemented: patient transitional care from hospital to home, collaborative care, interprofessional healthcare teams, medication therapy management (MTM), medication reconciliation, reducing barriers to prescription pickup, creation of a pharmacy home model (single point of medication record), extended drug interaction reviews for patients with 3 or more medications, 3-4 day callbacks, no more than 3 months of prescription drug renewal for selected medications, adoption of new health information technologies and greater use of generic medications, among others. And what do these efforts demand from pharmacists...the new "Medication Adherence Navigator®"? Yes...the need for more time...can I get Another Eight Hours Please®?
Any estimate of the potential daily additional pharmacist-hour effort could possibly reach 4-6 hours. Where can this extra time be found? Pharmacy staff will need "Pharmacy Up®" and automated counting, dispensing or packaging systems need be evaluated and most importantly...purchased...to support "A3", the Adherence Action Agenda. There are some 20 or more automated systems available from various manufacturers that might be considered candidates to support the needed "Another Eight Hours Please®". Pharmacists and pharmacy owners need do due diligence when automated systems are evaluated...significant equipment differences exist which can ensure pharmacist time availability. Until my next commentary, and as I like to say..."Thanks for coming in today®".