Adherence: You Can Make a Difference

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as Executive Director of the North Carolina Association of Pharmacists.

Many years ago, I heard a health economist state that “compliance [adherence] is a major problem looking for an owner.” A former Surgeon General around the same time said that drugs do not work in patients who do not take them. Has anything changed in the 30 years since those statements were made? A November 23, 2009, Business Week article discussed “10 ways to cut [health] care costs right now,” and mentioned that getting patients to take their medicine was one strategy to reduce health care costs right away because “3 of 4 Americans do not take their medicine as directed.”

It seems as though nothing has changed in all these years, except that we now have the studies to prove that patients who take their medications correctly have lower total health care costs. Furthermore, we also know that pharmacists can and do play an important role in coaching patients to be compliant. In the same Business Week article, John O’Brien, PharmD, MPH, assistant professor at the College of Notre Dame School of Pharmacy in Maryland, said it is “one of the best ways to improve care…and get more out of each health care dollar.”

Alarming Trends

Current trends regarding medication use are alarming:

• 75% of patients do not take their medications as prescribed.

• 49% of patients forget to take their medications.

• 31% of patients do not fill their prescriptions.

• 29% of patients stop taking their medications before their supply runs out.

• 24% of patients take less medication than the recommended dose.

So, which health profession should take ownership of this adherence problem to help patients use their medications correctly? Although our current pharmacy practice model makes it difficult for the dispensing pharmacist to assume this role, and the prescription drug reimbursement system fragments the drug distribution between several different pharmacy providers (ie, local pharmacy, mail-order pharmacy, specialty pharmacy), I think the profession of pharmacy is the most logical health profession to take ownership of this critical role. A definite need exists to improve the 2-way communication between the patient and their health care provider. What can the pharmacist do? The pharmacist can contribute by helping patients better understand exactly why it is important for them to take their medications as prescribed.

In suggesting that pharmacists take ownership of the adherence problem, I do not mean to oversimplify the solution. Medication adherence is a complex issue, and no one solution will work in every situation. The Boehringer Ingelheim Pharmacy Satisfaction 2009 Medication Adherence Report (www.pharmacysatisfaction.com) outlines 11 dimensions of nonadherence, and it proposes strategies aimed at increasing individual patient medication adherence and compliance at the pharmacy level. The National Council on Patient Information and Education’s “National Action Plan” (www.talkaboutrx.org) includes barriers to compliance, action steps, and recommendations. Based on studies that show that patients who understand health instructions make fewer mistakes, may get well sooner, or be able to better manage a chronic health condition, the National Patient Safety Foundation has initiated the Ask Me 3 program (www. npsf.org/askme3): (1) What is my main problem? (2) What do I need to do? (3) Why is it important I do this?

The Pharmacist as Coach

Clearly, many resources are available to help the pharmacist who wants to help patients use their medications appropriately. Yes, the problem can be complex, but the advantage the pharmacist has is the opportunity to work with the patient over a long period of time through regular interactions—acting as the patient’s coach. Such focused interactions lead to positive results. Here is my challenge: Rather than being overwhelmed with the size and complexity of the adherence problem, approach it 1 patient at a time. Identify 5 or 10 patients who could benefit from your help, and personally commit yourself to being those patients’ coach, helping them to make the best of their medications. You can make a difference. â– 

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