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Medication adherence: Are you in control of the biggest issue facing pharmacists?

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John Shaske excels at many things in his pharmacy, but a solid commitment to medication adherence ranks as one of his proudest achievements.

 

By Jack Kohane

Photography by Roger Handling

 

“Good patient outcomes drive pharmacy commerce,” says Shaske, pharmacist and former co-owner with Chris Juozaitis of Howe Sound Pharmacy in Gibsons, BC. “And one of the best ways to achieve good outcomes is to work with every patient at every visit to ensure they take their meds the way they should.”

Shaske points out that the key to his approach to improving adherence is holistic, requiring close collaboration among his entire pharmacy staff, currently comprising six pharmacists, four pharmacy technicians, and 15 assistants.

“You always need to keep focused on the pharmacy’s primary goal – to communicate drug therapy problems to the healthcare team – and at the same time you must solve or improve patients’ situations. We only carry OTCs that we will include in patients’ care plans. We have about $20,000 of stock out front. If we will not put it in a care plan, it will not be carried.”

Howe Sound Pharmacy exemplifies what most consider is the best of today’s pharmacy practices and principles, says Jim Danahy, founder and CEO of CustomerLAB, a retail productivity firm. “In this model, the pharmacist encounters the patient each time he or she fills or refills a prescription.”

Research has shown that when problems with appropriateness, effectiveness, and safety are solved, patients are willing and able to take medications as intended.

Growing focus

Medication adherence has long been a problem for pharmacists and prescribers, but since it was chosen as the keynote address topic for the Pharmacy U Toronto conference in January of 2013, adherence has gone from a problem to a priority embraced by the entire pharmacy sector. As keynote speaker Jim Danahy, CEO of CustomerLab, said at Pharmacy U:  “Medication adherence should be every community pharmacy’s highest priority to improve both public health and business viability.”

He argued that community pharmacies are the most effective point of care to help patients adhere to their medications. “And with half of all prescriptions for chronic medications going unfilled after six months, a multi-billion dollar funding formula is already in place without the need for permission from regulators or payers, just by filling the prescriptions that our existing patients need. This is a rare occasion when patient care and business priorities are so perfectly aligned.”

“Finally everyone is engaged in pursuing new adherence initiatives and research. What is most exciting is that the conversation has shifted from if we should do things differently to how.” said Danahy.

Taking action

Pharmacist John Shaske and David Cunningham, a partner in a chartered accounting firm specializing in pharmacy unit economics, joined forces with CustomerLab and several others to form a consortium called AdhereRx in 2013, specializing in the development of advanced tools and processes designed to transform the clinical, operational and financial aspects of medication adherence in community pharmacy settings.

Shaske led the design of the AdhereRx clinical process based on hospital practice, putting the pharmacist at intake to identify and address drug therapy problems before the wrong medications are dispensed.

When his pharmacy in Gibsons, BC implemented the process, their adherence rate was below the national average of 50 per cent.  “We are now over 90 per cent, according to AdherenceTRACK scorecard analysis,” he says.

AdhereRx pharmacy finance partner David Cunningham points out that any pharmacy can implement medication management on intake. While it requires a reengineering of workflow and may include modest staffing and dispensary millwork changes to accommodate intake seating for both patients and pharmacists, he says Howe Sound Pharmacy has digested a 60 per cent increase in prescriptions in the past two years, filling more than 650 Rxs per day.

“The average Canadian pharmacy filling 135 Rxs per day is losing as much as $1.5 million each year through the non-adherence of existing patients,” he notes. And that doesn’t include incremental revenue from fees related to the expanding scope of practice which help front line staff deliver better patient care and adherence.

Shaske contends that it’s crucial for pharmacists to interact with patients face to face, beginning with a comprehensive evaluation of all medications patients are taking, including prescription and nonprescription drugs, herbal products, as well as dietary/nutritional supplements.

He adds, “Death by prescribed medications is the fifth leading cause of death in Canada. It is preventable. Proper procedures make a big difference.”

 

Top tips for Rx adherence

  • Focus on drug therapy problem
  • Offer med reviews for all who need them
  • Reverse the flow…counsel patients at Rx drop-off
  • Adjust workflow policies and procedures, catch omissions, implement adaptations before dispensing
  • Ensure rigorous documentation and charting
  • Realize that ultimately good care IS good business

 

Medication adherence by the numbers

+ 50% of medications for chronic conditions are not being taken after six months of the first dispensation.

+ 12,500 Canadians die every year from non-adherence to cardiovascular medications alone.

+ Non-adherence is the fourth leading cause of accidental death in the US. It is crippling the Canadian healthcare system with $16 to 20 billion in preventable costs.

+ CustomerLAB estimates that non-adherence costs Canadian pharmacies $12.5 billion each year in lost sales. That’s 10 times the impact of generic drug reform, $1.5 million in lost sales for every store in the country, every year, or almost $4,000 a day.