Promoting adherence through the pharmacy channel
Pharmacists are in the right place, with the right kind of skills to improve patient adherence, says Steve Basiago, vice president, trade relations, Walgreens Health Services.
By on May 19, 2009Pharmacists are in the right place, with the right kind of skills to improve patient adherence, says Steve Basiago, vice president, trade relations, Walgreens Health Services. In fact, because pharmacists are readily accessible, they have about three times as much contact with patients as physicians do, he says.
A recent survey conducted by a large pharmaceutical company, Basiago told attendees at eyeforpharmas recent Patient Compliance USA summit, indicates that patients suffer a void in support between doctor visits. But pharmacists are well-positioned, he says, to help close that gap and improve compliance and adherence.
Medication experts and educators
Pharmacists, Basiago argues, have a lot going for them. First, they are medication experts, with detailed knowledge of medication therapy and the skills to manage drug therapy problems, he says. In addition, he stresses, they are capable of assessing a patients understanding of his/her illness and treatment; discussing any barriers or obstacles to adherence patients might have, uncovering individual patients problems and coaching and encouraging healthy behavior.
Its clear that current medical practice constrains physicians, Basiago says. Their schedules dont allow the time necessary to discuss drug therapy, goals, and the value proposition of a prescribed treatment, the potential side effects of drugs, or the value of therapy adherence. This lack of time (and third party reimbursement) for doctors to manage drug therapy also limits the care patients receive between visits with their doctors, Basiago says. And these are all things that, when done by doctors, have been shown to increase adherence.
Pharmacists can pick up this responsibility, Basiago says.
Confidence and conviction
Although the major reason for non-adherence reported by patients is forgetting to take their medicine, he says there also are underlying confidence and conviction problems, including not thinking the medication is necessary or working, concerns about side effects, worries about dependency and expense and a general dislike for taking medication.
Adherent patients simply have more confidence and conviction, Basiago says. And although adherence issues can crop up anywhere in the drug taking cycle, prevalence is greatest early in therapy, he says, making early interventions with patients of significant value.
Particularly in patients that are new to therapy, Basiago says, helping them reach concordance, building confidence by providing information need to make decisions to accept treatment recommendations and fostering commitment to help patients see the value of successful therapy can all positively impact adherence.
Conviction is usually high, since theyve decided to pursue treatment, he says, but confidence can be low or falsely high when people dont know what they dont know. Most are still grappling with the diagnosis, which is emotionally charged, and may not be capable of processing everything. And health literacy is lower than you might think.
Understanding the value proposition
Education alone is not enough, Basiago says, but helping patients to understand the value proposition the risk and benefits is important.
For patients who are not new to a therapy, he says pharmacists can intervene with refill reminders that will help patients overcome inertia and ambivalence. By simply providing a subtle reminder that someone is watching, you can make it easier for patients to take action and order refills, Basiago says. But the tactic does not overcome barriers such as low confidence or commitment and cost issues, he says.
He suggests that successful interventions can be achieved by:
Focusing on the known drivers of non-adherence for a specific drug
Listening closely for clues of underlying problems
Letting patients problem-solve with you to help build confidence and renew conviction
Working on simple solutions and discussing the rewards of staying healthy if confidence is low
It's all in the approach
In the pharmacy channel, Basiago says, four approaches can be used: direct mail, automated phone calls, live agent phone calls and face-to-face encounters. While direct mail is low cost and easy to scale, it offers no interactivity with patients and minimal customization and may suffer from a lack of timeliness. It is, however, an effective way to offer educational information on medication and the disease state or condition.
Automated phone calls (most often used for refill reminders) are customizable to groups, while still being low cost and easy to use. But, again, interactivity with patients is limited, contact is not customizable to individual patients and interactions are not real-time. The channel does, however, offer opportunities to deliver educational information about medications, onset of action and common side effects and mitigation strategies, Basiago says.
Although similar in the education benefits it offers, live agent phone calls also are interactive and can be tailored to be patient specific, but may fall down when it comes to capacity and consistency of the information provided. In addition, such calls are not real-time and are high cost.
While sporting the highest cost, face-to-face interactions are real-time, interactive and patient-specific. But consistency remains a problem, as does the impact such interactions have on a pharmacists workflow.
The bottom line, Basiago says, is that although program costs go up as they become more patient-specific, such interventions deliver the best results. The highest cost programs may be your best investment, he says. And he argues that the pharmacy channel may be the best promotional channel overall.