Adherence Challenges Differ Across Community Pharmacies

Community chain pharmacies vary in the barriers they face when implementing programs to improve medication therapy management (MTM), according to research published in the November-December 2014 issue of the Journal of the American Pharmacists Association.

Jennifer L. Bacci, PharmD, and colleagues from the University of Pittsburgh School of Pharmacy built upon previously published research from the Pennsylvania Project, which determined that community pharmacists significantly aid patients with medication adherence and can thus contribute to the movement towards payment for care quality. The current research team interviewed 10 pharmacists from “early adopter” practices, defined as meeting all 5 medication adherence metrics, and 5 pharmacists from “traditionalist” practices, defined as meeting 2 or fewer adherence metrics.

From those interviews, the investigators identified 5 dominant themes that influenced the implementation of targeted MTM interventions. The first theme involved pharmacists’ understanding of the relationship between their patient care programs and their chain pharmacy’s vision. Both early adopters and traditionalists felt overwhelmed by the amount of clinical initiatives, especially in determining how to prioritize new corporate initiatives alongside their regular dispensing and immunization duties.

The second theme involved pharmacists’ need for continual support and mentoring. For instance, those who received onsite, individualized training felt more comfortable implementing targeted medication adherence interventions, and they indicated that such support should include assistance with prioritizing clinical and dispensing initiatives, feedback on how well they were performing, and updates about the projects.

The third theme, which encompassed barriers to MTM program implementation, differed between the traditionalist and early adopter community pharmacies. The former pharmacies faced barriers related to inconsistent staffing and patient population needs of specific communities, while the latter ones faced roadblocks related to patient population and the later implementation stages. Furthermore, “early adopters faced barriers that they would be able to solve on their own at the individual practice level through relationship building with patients and practitioners in the area, (but) traditionalists had barriers at the pharmacy level that they were unable to solve on their own,” the authors wrote.

The pharmacists also recognized active patient engagement as a key facilitator for MTM programs. While early adoptors had an established work flow that incorporated patients and fostered patient-pharmacist therapeutic relationships, traditionalists encountered the same barriers from the third theme when they tried to engage with their patients.

The final theme acknowledged pharmacists’ desire to hear what is working or not working at other pharmacies, as well as share their own insight into best practices. In addition, the pharmacists found it was helpful to set short-term goals for their teams to share, and that successful implementation of targeted adherence interventions was best achieved through persistent patient discussions.

“Patients clearly need to receive more focused, medication-related care in their own communities. Community pharmacists have the knowledge and skills to provide this care while being the most accessible health care practitioner,” the authors wrote. “…This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.”

The researchers said their findings shed light on the importance of frontline pharmacists and ancillary staff to understand the purpose of the patient care initiatives they are being asked to implement, and how they can complement other services offered by their chain organizations.