Community Pharmacists Find Discussing Adherence Difficult

Pharmacists find monitoring medication adherence difficult due to time constraints and other barriers, according to research published in the Journal of American Pharmacists Association.

Researchers from the College of Pharmacy at the University of Iowa interviewed 12 community pharmacists between January and March 2013. Of those pharmacists, 6 had a reputation of engaging in medication monitoring activities and were specially selected, while the remaining 6 pharmacists were recruited from a group of 20 randomly selected registered community pharmacists to fulfill the following characteristics: chain (3), independent (7), and grocery pharmacy (2); urban (7) and rural (5) pharmacy; male (3) and female (9) pharmacists; and full-time, float, and part-time pharmacists.

In a semi-structured format, pharmacists were guided in their questions to discuss topics such as recent or memorable experiences in which they interacted with patients taking long-term medications and talked about refilling their prescriptions.

In the interviews, pharmacists discussed a desire to be helpful, enjoyed making a positive impact for patients, and developed problem-solving and communication skills. They also focused on business in the pharmacy and the limitations they faced, and they discussed the service orientation of their pharmacy as a means to highlight how it differs from others.

The pharmacists also acknowledged in their interviews that the dispensing sessions could be used as an extra patient monitoring conversation, but they noted that such action was not consistently taken. In addition, some interviewees mentioned that new prescriptions written for medications that a patient was already familiar with involved less or no counseling due to the previous use.

Problems that pharmacists encountered during their counseling sessions were medication nonadherence and side effect monitoring, and they cited business, late refills, and technical issues as the most common reasons behind the minimal effort devoted to improving drug compliance. Other pharmacists cited not wanting to be confrontational as a reason for avoiding discussions on nonadherence.

“Pharmacies wishing to increase patient perceptions of service quality and pharmacist—patient relationship quality may be advised to work against the perception that refills are routine and can be dispensed without periodic attention,” the authors concluded. “…Pharmacists should be encouraged to approach patient nonadherence from a broad perspective, perhaps using an adherence questionnaire and a patient-centered interaction approach designed to solicit the mediation-use experiences of the patient. This emphasis could be particularly useful for dispensing workflows that incorporate medication synchronization or appointment-based refill interventions to bolster medication adherence.”

The pharmacists also struggled with the time gap between attempting to engage in medication monitoring after a pharmacist or technician identifies a potential problem as a patient is picking up a prescription. Pharmacists agreed that they commonly write notes on the information sheet and believed it was the responsibility of whoever handed the patient the prescription to go over it in more detail. Some pharmacies found that turning this process into an electric one had stronger, more consistent results.

The pharmacists cited dosage increases and ensuring that the patient was receiving all of their prescribed medications as 2 additional sources for starting conversation on medication adherence interventions.