Medication Adherence: Taking Responsibility

Pharmacists can help break the cycle of nonadherence, which has a huge impact on patient safety and is a significant financial burden.

One of my Father’s Day gifts this year was a copy of Clayton Christensen’s book, The Innovator’s Prescription. Christensen is the Harvard Business School professor who originated the theory of “disruptive innovation”—the process that enables a product or service to get established in simple applications at the market’s bottom, and then move “up-market” to end up replacing established competitors. He and his colleagues are now applying this theory to health care and higher education. Upon reading this book, I can see how it directly applies to health care, and especially pharmacy.

The American Pharmacists Association (APhA) has invited Christensen in the past to make presentations at several of its conventions. Recently, he was also the main speaker at the National Conference of Pharmaceutical Organizations (NCPO).

One of his observations is that pharmacists are well positioned to provide selected chronic disease management services. The NCPO program participants applied this recommendation to pharmacy by suggesting that “The pharmacy profession must take responsibility for adherence. It is the most basic medication therapy management service; pharmacists serve as a mechanism for monitoring what patients are doing and holding them accountable for adhering to prescribed therapies and behavior change,” as reported by APhA.

Although some pharmacy clinicians may feel that adherence management is beneath their skill level, Christensen suggests that rather than start trying to offer services that compete with established providers, pharmacists should start by offering services that are not now routinely offered by other practitioners. Presently, no health care professional owns adherence management.

If pharmacy claims this role, the profession is not stepping on anyone else’s toes. As pharmacists are established in this direct patient care role, I believe that payment will follow.

More importantly, pharmacists will soon be able to “up-market” their services to collaborative drug therapy management of chronic disease. This “disruptive innovation” will lead to an expanded role for pharmacy—and that’s a good thing and something we’ve been talking about for a long time.

Pharmacy is the most logical group to take on this role since most prescriptions are still filled in the community, and pharmacists are still the most accessible health care professionals. Nonadherence results in 125,000 deaths annually. It also causes 33% to 69% of hospital admissions and increases health care costs from $100,000 to $300,000, according to the Script Your Future website.

Several resources are available to help pharmacists start an adherence monitoring program, including www.ncpanet.org/adherence, http://scriptyourfuture.org, and http://pcpcc.net.

Another program that will help with improving a patient’s medication adherence is one to get a patient’s refills to occur at the same time each month. Although such a program takes effort to set up initially—and payers or patients will need to work with you to get it done—reports from those who have implemented such a program say that it does improve adherence. More importantly, it improves the pharmacy work load.

If medication therapy management is the key to pharmacy’s future, a medication adherence program would be a very good place to start

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is past executive director of the North Carolina Association of Pharmacists