Patient Access to Clinical Pharmacists Can Improve Medication Adherence

The development and proliferation of prescription medications, such as antibiotics, statins, asthma medications, and other lifesaving medications, are perhaps one of the greatest medical and scientific achievements in human history. Not only have prescription medications increased the average lifespan dramatically, but they allow us to maintain a higher quality of life.

However, even the most effective medications only work when medication adherence is consistent and prescriptions are consistently filled and taken as prescribed. Medication adherence is critical to ensuring that a patient’s prescription is as effective as intended. Generally, medication adherence at 80% or greater is required for the medication to be effective. Let’s explore the current state of medication adherence in the United States health care system, its challenges, and how we can work towards improvements.

Medication Adherence Today
Based on the data, investigators have even determined that medication adherence can have a greater impact on a patient’s health outcomes than the treatment. This means that consistently taking a medication as prescribed could matter more in relation to health outcomes than a prescriber’s actual choice of medication.

Most patients don’t truly comprehend the importance of taking their medications as intended; in fact, it’s estimated that 125,000 deaths in the US each year can be attributed to medication nonadherence, not to mention up to half of treatment failures and a quarter of hospitalizations every year. It’s clear that medication nonadherence is an epidemic in the US that is not only hurting our health, but raising the cost of health care, with an estimated $100 billion to $300 billion cost tied to nonadherence.¹

Medication Adherence in Complex Populations
Populations with chronic conditions, advanced age, or mental health conditions also have some special considerations in terms of the importance of medication nonadherence. For example, diabetes is a chronic health condition with one of the highest numbers of patients with the disease in the United States. In a 2020 report from the CDC, approximately 13% of US adults are estimated to be diabetic in the country. Further, studies have shown that when patients with diabetes have low medication adherence, their health suffers significantly. Poor medication adherence for patients with diabetes can create difficulty controlling blood sugar, which has downstream effects including decreased quality of life, increased hospital visits, and premature death.^2,3

However, one of the patient populations suffering the most from the effects of medication nonadherence are older adults. Older adults are more likely to have poor medication adherence rates due to factors like confusion caused by numerous medications being prescribed, low health literacy, and financial challenges related to affordability. For an older adult with multiple chronic conditions, inadequate adherence to their medication regimen can result in worsening symptoms, advanced disease states, and the need for more costly hospital care.⁴

Additionally, despite the lack of physical manifestations of symptoms for many patients with mental health conditions, remaining adherent to mental health medications is just as important as with other drugs. Unfortunately, medication adherence in patients with mental health conditions is a difficult issue to correct, with more than half of patients not properly following their medication regimens as prescribed. In patients with mental health conditions, relationship building between patient and clinician is critical because nonadherence often originates from a distrust in the health care system and/or the competence of the care team.⁵

Greater Access to Clinical Pharmacists Can Improve Adherence

When most people imagine a pharmacist, they visualize someone in a white coat standing behind a counter at their local grocery store or pharmacy, dispensing medications to a long line of people. While dispensing is certainly a traditional career pathway pharmacists can choose, there are many other applications for pharmacists in health care today.

Clinical pharmacists are the foremost experts on medications within health care. In the same way that a patient may have a cardiologist who specializes in caring for heart conditions or a gastroenterologist who specializes in digestive conditions, there are pharmacists who specialize in the treatment of particular conditions using pharmaceutical medications. These pharmacists are highly knowledgeable in the medications in which they specialize, with expertise in adverse effects (AEs), drug interactions, and identifying duplicative medications.

If we’re trying to improve medication adherence, it just makes sense to look to the pharmacist. Specifically, pharmacist-led clinical consultations have been shown to improve patient adherence to medication plans for several reasons:

• Clinical pharmacists are generally more trusted by patients and therefore patients may be more open to their guidance on the proper use of their prescriptions.
• When using a telephonic clinical pharmacy platform, pharmacists can proactively reach out to patients to counsel on medications and ensure that they remain adherent.
• If a patient is hesitant to take a medication because it’s causing AEs, a clinical pharmacist can efficiently document that information and engage their prescriber to make appropriate changes to the drug regimen.
• Many pharmacists are expertly trained in motivational interviewing, a practice that encourages clinicians to meet patients where they are, delivering a friendly and helpful approach rather than a parental or scolding attitude when counseling in appropriate medication use.

Health plans, provider groups, and other strategic partners, including pharmacy benefit managers, can partner with clinical pharmacists to engage patients and conduct outreach. Greater accessibility to clinical pharmacists and engagement on medications specifically can encourage better medication adherence, ultimately impacting patients’ health outcomes to their prescribed treatments.

About the Author

David Medvedeff is the co-founder and CEO of Aspen RxHealth.

References

1. Kim J, Combs K, Downs J, Tillman F. Medication Adherence: The Elephant in the Room. US Pharmacist. January 19, 2018. Accessed February 6, 2023. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room
2. CDC. Estimates of Diabetes and Its Burden in the United States, National Diabetes Statistics Report 2020 Estimates of diabetes and its burden in the United States. CDC website. 2020. Accessed February 6, 2023. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
3. Kocurek B. Promoting Medication Adherence in Older Adults . . . and the Rest of Us. Diabetes Spectrum. 2009;22(2):80-84. doi:10.2337/diaspect.22.2.80
4. Georgetown University School of Nursing. Improving Medication Adherence in Older Adults, Improving Medication Adherence in Older Adults. March 21, 2022. Accessed February 6, 2023. https://online.nursing.georgetown.edu/blog/improving-medication-adherence-in-older-adults/
5. Casey T. Poor Adherence Rates among Patients with Mental Illness. Population Health Learning Network. Poor Adherence Rates among Patients with Mental Illness. December 2014. Accessed February 6, 2023. https://www.hmpgloballearningnetwork.com/site/frmc/articles/poor-adherence-rates-among-patients-mental-illness