Health IT

How to make medication adherence plans work from an operational perspective

“Pharmacists are in the ideal position to help with adherence in terms of explaining the purpose of medications, how to take them, and the importance of staying on them. They are in a sense the most accessible providers in the health care system, but often are underutilized as a resource for improving medication adherence.” My […]

“Pharmacists are in the ideal position to help with adherence in terms of explaining the purpose of medications, how to take them, and the importance of staying on them. They are in a sense the most accessible providers in the health care system, but often are underutilized as a resource for improving medication adherence.”

My colleague Vickie Andros, director of clinical services for Curant Health, explained how pharmacists can help patients stay on a treatment plan. Having the right people in place is a key to success. But how do you make such an adherence plan work from an operational perspective? Here are the five components that have worked for us.

Patient onboarding and discovery

Medication triage is the foundation for long-term success, and identifying and communicating with all care providers is step one. The goal at this stage is taking action to reduce unnecessary or contradictory medications, reduce the number of physicians a patient must see (if possible), and reduce the number of patient visits. Because access and transportation to physicians, clinicians, and pharmacies is often a significant barrier to adherence, these steps and the associated goals form the foundation of an effective adherence program for chronically ill patients.

Intake coordinators, who should be licensed pharmaceutical technicians, are the first to communicate with new patients. They acquire information related to patient demographics and the patient’s professional care team to identify any issue that may present a barrier to adherence and then immediately brief one of our pharmacists on the case. Medication reconciliation is the next step and occurs via outreach to, and consultation with, physicians, specialists and other pharmacists involved in the patient’s care history.

Nearly every new patient presents with some type of issue that is detrimental to adherence. Whether it is a need for co-pay assistance, lack of a care team outside of the physician’s office, lack of proper insurance, lack of understanding his own lifestyle, or a mis-prescribed medication, these issues need to be identified and solved up front.

Removing barriers to adherence is a priority. For example, when a patient is eligible for co-pay assistance, a patient care coordinator takes the reins from the intake pharmacist, starts building a rapport with the patient, dives into the nitty gritty on delivery and refill details, discovers if and where assistance is available, then takes the steps required to actually assign the co-pay assistance to the patient’s medication.

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Making it easy

Long-term, a care team must make it very, very easy for patients with chronic conditions to remain adherent. One way to accomplish this is to give the medication fulfillment process structure so patients don’t have to think about it, they just do it. Scheduling and refill reminder alerts are part of this process along with customized packaging that simplifies management of multiple medications.

We describe complicated medication regimens as anywhere between eight medications all the way up to 30. It is nearly impossible for a coherent person to manage such regimens without some kind of assistance, especially when prescribed administration spans different times of day. The odds of getting medications into a counter or organizer correctly for a chronically ill or aging patient is slim, even by a healthy, highly aware caretaker.

Many patients say that traditional pill bottles increase adherence because of their familiarity and discretion. Home delivery is a big contributor to improving adherence and outcomes as well.

Delivery and timing – the process and logistics challenge
Curant Health fills approximately 500,000 prescriptions per year. Two of the four company principals are engineers, which is lucky for us because effectively managing this level of fulfillment is literally a feat of engineering. Multiple backups (including personnel), multiple facilities and alternate delivery methods are necessary in the event of an emergency – like an ice storm in Atlanta. Patients can’t take their meds if the therapies don’t reach them the right way, or at all.

The calls – a high-touch essential
The entire patient care team needs to know if patients are adhering to their medication therapies, and if not, why not and what can be done to fix it. Adjusting timing can be an option, while adjusting the medications themselves in coordination with the physician is another. Determining the best course of action is a soft art, and there is no substitute for direct contact, discovery, rapport and trust.

Patient care coordinators speak with the patients they are responsible for at least once per month, building familiarity and trust. This supports consistency, patient retention and ultimately improves outcomes and quality of life.

When a team member identifies a potentially high risk of non-adherence, the intensity of communication is ratcheted up. Whatever the problem, the team must coordinate its efforts and spring into action. The issue and prospective solutions are communicated with the appropriate care team, insurer, physician, medication therapy managers and pharmacists in a great flurry of concerted activity.

Documentation – What happens between physician visits?

We developed our own in-house patient support platform, MedPlan ™, which was recognized as a grand finalist for the 2013 Microsoft Excellence in Innovation Award. All of the activities described above are digitally tracked and recorded using this system. Incomplete or incorrect records would nullify the very idea of treating the whole patient, so we take record keeping very seriously.

The data we acquire gets populated into a secure database and gives clinical partners a real view into what the patient is doing after she walks out of the offices. Every touch that takes place outside hospital, clinic or physician EMR systems lives in our database.

At the end of the day, all of our efforts support this truth: excellent adherence is critical to improving outcomes, lives, and lowering overall healthcare spends.

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