The community pharmacy’s role in patient adherence
Andrew Tolve explores how pharma firms can support pharmacies to benefit patients, stakeholders, and their bottom lines
According to the World Health Organization, between 30 and 50 percent of medicines prescribed for chronic diseases are not taken as directed.
Statistics for medicines that address acute diseases are better, but not by much. Patients deliberately avoid prescriptions; they forget to pick them up; they take them haphazardly.
Non-adherence costs the pharma industry billions every year and leads to both disease escalation and deaths. But pharmacists can help.
Not only are pharmacists present at the point of distribution, but patients trust them and are eager for their direction and advice.
By partnering with pharmacies and helping to establish frontline services, pharma companies can help patients, stakeholders, and their bottom lines.
The ideal relationship between pharmacies and pharma is one of “partnership,” according to Michael Holden, chief executive of the UK National Pharmacy Association.
“Pharmacists see patients around four times as often as anyone else in the healthcare system, so we need to leverage that interaction to support adherence.”
Elizabeth Oyekan, area pharmacy director at Kaiser Permanente, the largest managed care organization in the US, says this can be a “win-win-win” for patients, pharmacists, and pharma.
“It’s a win for patients because they’re healthier,” she says.
“It’s a win for pharmacies because their patients are healthier as is their bottom line. And it’s a win for pharma because they sell more drugs and spend less time and money searching for new ones.”
Mark Ireland, director of pharmacy contract and project development at Boots, a leading UK pharmacy chain, agrees.
“The [pharma] industry invests billions through the medicine development process to prove beyond doubt the clinical effectiveness of its products,” he says. “This is hampered by patients failing to adhere to the medicines they are prescribed, causing governments and patients not to realize the full potential benefits.”
The trust that patients have in pharmacists and the expertise of pharmacists “needs to be leveraged to solve this issue,” according to Ireland. (For more on pharmacists’ impact on adherence, see How pharmacists can help improve patient compliance.)
The role of the community pharmacy
The community pharmacy is a good place to start.
In the past few years, big box establishments have put community pharmacies under threat.
In the US, Wal-Mart, Target, and Walgreens have come to dominate the pharmacy market.
Wal-Mart offers $4 prescriptions for dozens of generic drugs, a tough program for community pharmacies to match.
While some community pharmacies have folded, others on both sides of the Atlantic have proven resilient.
They’ve joined together to negotiate bulk-buying discounts the same way nationwide chains do.
More importantly, they’ve tried to fully embrace the “community” aspect of community pharmacy.
Patients, empowered by online information and frustrated with overcrowded doctors’ offices, are hungry for personal attention in the pharmacy setting.
This is something local pharmacies can provide through drug management and adherence outreach services; they can also use it to distinguish themselves from their big box competitors.
“All of a sudden, throughout community pharmacy, everyone is focused on improving services and offering real value to the patient,” says Oyekan.
“Year after year, this is becoming more of an expectation and a need.” (For the views of Ema Paulino, a member of the board of the Italian National Association of Pharmacies, on pharmacists, see The pharmacist's role in patient adherence.)
The value-added pharmacy
Many pharmacies are already experimenting with value-added services.
In community pharmacies in the US, medication therapy management (MTM) programs have become popular.
In addition to dispensing drugs, pharmacists in MTM programs provide comprehensive reviews that check for medication appropriateness as well as problems with adherence and side effects or adverse events.
“We believe the pharmacist model of the future is that community pharmacies will be service-based entities that will encompass a wide variety of these service offerings under the umbrella of medication therapy management,” says Jim Owen, director of professional practice, the American Pharmacists Association. (For more on MTM, see Patient compliance and medication therapy management.)
Meanwhile in Europe, medicine usage reviews and chronic medication services are gaining traction due to growing government awareness and support.
Pharmacists on both continents have rolled out campaigns to address and improve patient adherence.
These programs often use interactive voice recognition (IVR) tools to reach out to patients who are late picking up drugs.
Simpler iterations involve pharmacists and nurses hitting the phone lines on weekends to reach out to patients.
For example, CVS recently introduced its Patient Care Initiative and Kaiser unveiled B-SMART, a comprehensive manifesto for medication adherence in its community pharmacies.
“We’ve trained our pharmacists so that when a patient is deemed non-adherent, we have a very systematic way of addressing that patient to help them get back on track,” says Oyekan.
The need for systemic support
Despite the momentum behind value-added services, pharmacies still need help.
“The pharmacist is at a tipping point when small things can make a big difference,” Holden says.
“We have to put more ownership of treatment in the hands of patients and support them through education and behavior change. The pharma industry has a major role in facilitating that.”
As Ireland points out, pharmacists manage a very complex supply chain and dispensing process that’s highly regulated and controlled in all European markets.
This means that there have to be strong operational processes.
“Trying to overlay medicine adherence services over this from different providers for different medicines creates chaos and poor delivery by pharmacy operators regardless of the effort that they put in,” he observes.
So there is a strong need for a more generic service for specific disease areas that pharmacists can offer to all patients, which can then be developed to layer in specific drug services as required by the patient.
“I believe that pharma has a lot that it could offer to setting up such a program,” says Ireland.
Holden highlights the usefulness of quick reference guides that provide clinical updates and share tips on how to handle certain situations or certain molecules.
Oyekan notes that the need for large-scale, systemic support is equally acute in the US.
“If pharma can help community pharmacies work on systematizing and standardizing programs that can then be implemented around adherence and medication optimization, that becomes a value-added service as well as a win-win,” she says.
(For more on standardizing adherence programs, see The pharmacist as an ally in patient adherence and Patient Compliance and Specialty Pharmacy Products.)
On the adherence front, pharmacies are in need of predictive tools that proactively identify patients at risk of non-adherence.
Reaching out to patients after they’ve missed their prescriptions is relatively straightforward.
Predicting which patients are likely to do this—and then enrolling them in disease management programs—is much more difficult but also much more valuable.
Again, pharma can help.
Merck, for instance, offers the Adherence Estimator, a three-question form that 2010 research showed to be 86 percent accurate in identifying patients at risk of non-adherence.
Merck is in the process of partnering with pharmacies.
“This will help community pharmacies pursue high-risk patients more aggressively from the start,” says Oyekan.
“The bottom line is that we need to reduce the health burden of the patient, improve the care experience, and reduce overall healthcare costs,” she concludes.
“Helping pharmacies better manage and dispense drugs to more adherent patients is a powerful way to accomplish that.”
For everything patient-related, join the industry’s other key players at Patient Adherence, Communication and Engagement (PACE) USA on October 24-25 in Philadelphia. Download the full PACE agenda and speaker line-up here. Want to know more? Contact email@example.com.
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