The pharmacist as an ally in patient adherence

Stacey Irving, director of channel marketing at McKesson, on how pharmacists can help increase compliance.



Stacey Irving, director of channel marketing at McKesson, on how pharmacists can help increase compliance.



Pharmacists are an underutilized resource in our healthcare system, says Stacey Irving, director of channel marketing at McKesson. She points out that as the process of dispensing prescriptions is now much more efficient, time is freed up that pharmacists can use for patient relationships.


To exploit this, partnerships between manufacturers and pharmacies are needed. But retailers don't have the right organizational structures to do this.


For this reason, McKesson set up the Pharmacy Outreach Network, which includes 2,500 independent community pharmacies and four regional and national chains. The aim was to increase patient adherence through a series of targeted behavior modification interventions delivered by the pharmacist at point of sale.


Changing health behaviors


Irving explains how the Pharmacy Intervention Program was piloted. An advisory panel, including pharmacists, concluded that there was an average of five minutes available for counseling each patient at the time of dispensing. This time budget was to be spent on interventions based on the principles of health behavior change and motivational interviewing.


Training in these techniques was delivered via the Pharmacy Outreach Network and results were measured using adherence industry best practices in collaboration with the manufacturers' analytics teams. Irving strongly emphasizes the need for an empathic approach by the pharmacy staff delivering the interventions. Pharmacists are at times as guilty as physicians in taking a paternalistic approach, she warns.


Learning to listen


Using mostly online training, a non-judgmental and non-confrontational approach was embedded. Open questioning was a key tool, highlighting the need to listen and not just to talk. Using this technique, patients acceptance and commitment to behavior change was much more likely to be the outcome.


Pharmacists were trained to listen for key words and phrases that signaled this acceptance. This in particular helped them to become more deeply involved in counseling patients, and they reported back enthusiastically on the successes they were having.


How it works


Irving outlines the intervention model used: When a patient comes in and presents their prescription, we can look at some of the qualities of the claim and apply business rules. If the rules determine that the claim is eligible for one of the sponsored programs, the pharmacist is notified that the relevant intervention can be given. At this time, various counseling reminders can be given, including a fax to the pharmacy.


This works because there is a short time between the claim being notified and the patient collecting their medication. Brand-related patient-facing materials as well as disease-specific materials are often supplied to support the conversation. After the intervention, the pharmacist makes a claim and the cost of the counseling intervention is processed as per a conventional claim. A recent development is the facility to capture counseling opportunities that have been missed, along with the reasons.


Intervention increases adherence


The Pharmacy Intervention Program was piloted in two categories, smoking cessation and COPD, launching in summer 2008. Irving reports that the pilot was very successful, with over 500 pharmacies participating.


In the COPD category, at the seventh prescription fill there was a mean 38% increase in fill rate, showing that pharmacy intervention does increase adherence. This translates into 31 more pills for intervention patients versus controls, and for the whole program a 557% return on investment.


The smoking cessation category would have been expected to be more difficult, Irving considers, as it involved a commitment to move away from an addiction. As expected, there was a sharp decline in overall prescription fill rate, with only 13.5% of control patients coming in for the third fill. However 20% of intervention patients did so, a 48% improvement.


These were very difficult patients, Irving emphasizes, and a very short interaction. In the light of the large amounts of clinician time spent on helping people to give up smoking, this program looks like very good value.


Value indeed is a key word for Irving. She recommends looking carefully at the value of pharmacists and the role they can play in healthcare. They have trusted relationships with patients, and are very willing to contribute.


For more on pharmacists and patient compliance, see How Pharmacists Can Help Improve Patient Compliance.