by Charles D. Shively, Ph.D., R.Ph.

Adherence. New word to pharmacists? New word to patients? New role for pharmacists? New role for patients? For medication adherence to be successful, the patient must embrace an “I’m helping myself” posture regarding his or her health. Webster’s New Collegiate Dictionary includes several definitions for the word adhere and for the act of adherence, and even a name given to one who adheres — adherent. As the act of adherence is about being consistent, giving support, and maintaining loyalty, both pharmacists (as adherents) and their patients (also as adherents) will need to engage more extensively — cojoin if you will — to effect success in the patient’s medication adherence.

The 2007 National Mobilization Call

Enhanced pharmacist efforts to improve adherence have been in place for several years following a report in 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 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.

The A3 Project

This latest action plan, the NCPIE Adherence Action Agenda, contains 10 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% to 30% of prescriptions are never filled by patients, and 50% to 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 nonadherence ($72.5 billion is spent on hospitalizations alone — some 69%).

What Areas of Pharmacy Must Pharmacy Up to This New Challenge?

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 (a single point of medication record), extended drug interaction reviews for patients with three or more medications,three to four-day callbacks, no more than three 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?

Automated Pharmacy Systems to the Rescue!

Any estimate of the potential daily additional pharmacist-hour effort could possibly reach four to six hours. Where can this extra time be found? Pharmacy staff will need to pharmacy up: 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 to do due diligence when automated systems are evaluated. Significant equipment differences exist that can ensure pharmacist time availability. Until my next commentary, and as I like to say, thanks for coming in today. CT

Charles Shively is chief executive and pharmacy officer of www.PharmacyCE.com and www.HealthcareLearnings.com