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Addressing Nonadherence: What Pharmacists Can Do

Pharmacists have a golden opportunity to promote medication adherence — improving patient outcomes and protecting revenue

By Paula Bickley and Ashleigh Burdette

Paula Bickley, vice president of market access, Biologics by McKesson

Ashleigh Burdette, MSN, RN, OCN, senior director of clinical innovation, Biologics by McKesson

severity and managing comorbidities; therapy-related factors such as side effects; health system and caregiving factors, including the level of comfort between patient and provider; and socioeconomic factors, such as financial barriers to treatment.

Every patient is different, and every patient will have a different reason for not complying to therapy. This makes solving adherence issues a complex and challenging task. The key is meeting the patient where they are and understanding their unique circumstances. That way, all clinician actions can result in better care for the patient, driving optimal outcomes overall.

When a 60-year-old endometrial cancer patient almost skipped her medication due to a side effect of acute high blood pressure, her specialty pharmacy care team took action. Communicating with her provider, the team advised a dose change to counteract the side effect, helping the patient manage her blood pressure yet stay on therapy — avoiding nonadherence and increasing her chances for a better outcome.

Medication nonadherence is a common problem with staggering effects: Approximately 30% to 50% of U.S. adults do not remain adherent to their long-term medications, resulting in about $100 billion a year in preventable healthcare costs. Perhaps the biggest driver of unnecessary medical spend, nonadherence affects all stakeholders, from the health of patients to the bottom lines of payers, health systems and pharmacies.

The endometrial cancer patient’s care team was the high-touch specialty pharmacy Biologics by McKesson. However, retail pharmacies too are well positioned to address the issue of nonadherence. The benefits of taking action are many: improved patient care, stronger customer relationships and fewer emergency room visits.

Putting the Patient First

Retail pharmacists have more opportunities than many healthcare providers for one-on-one interactions with patients. Yet the risks for nonadherence often go unrecognized, resulting in a missed opportunity to keep the patient on track.

Addressing nonadherence starts with a focus on patientcentered care, and with an understanding of the multiple factors that can prevent a patient from complying with treatment. The World Health Organization has recognized five key areas proven to impact a patient’s ability to remain adherent to long-term therapy. These include the patient’s attitudes and beliefs, including confidence and motivation; disease-related factors, such as symptom

Rethinking the Pharmacy Workflow

At Biologics by McKesson, an individualized approach to patient management involves making a care plan that’s tailored to each patient’s circumstances. A care plan is a vital part of the nursing process and provides a centralized place to document the patient’s challenges, goals and progress as well as any education needed. We have found that patients on care plans experienced fewer adverse event-related therapy discontinuations; notably, high-risk patients had a 35% reduction in the rate of hospitalization.

While creating a detailed care plan is not always possible in a retail setting with a high patient volume, a pharmacist in any setting can still create a model that meets the patient where they are. Pharmacists shouldn’t miss an opportunity to get to know patients and understand their challenges — which is critical for developing a meaningful and effective plan of care that provides value for all stakeholders.

Putting the patient first might involve rethinking the pharmacy workflow to include an ability to counsel patients more broadly through tools such as risk-assessment questionnaires, checklists or conversation starters. Also, it could involve a retail pharmacy partnering with a specialty pharmacy and developing a collaborative relationship that simply starts with a pharmacist-topharmacist conversation.

Patient-centered care, however a pharmacy can best provide it, truly is key to improved patient adherence. Failure to take medication properly is likely the reason for up to two-thirds of hospital admissions in a year, most of which are unavoidable if patients have the clinical support they really need. Although adherencerelated hospitalizations are expensive, they’re also avoidable, which is great news for both patients and payers alike. When pharmacists focus on patients, they make a difference across the healthcare continuum. dsn