In our previous blog, we delved into how fear and confusion can negatively impact medication adherence. Now we will examine how health beliefs and finances can influence patients and a service we as pharmacists can provide to improve outcomes.
Health Beliefs. A difficult barrier pharmacists must overcome to improve adherence is the health beliefs our patients have towards medications, their disease states, and health care in general. A study examined how health beliefs impacted medication adherence in patients being treated for HIV/AIDs and discovered that those patients who were asymptomatic were more likely to be non-adherent, while those who experienced negative effects from their disease were more likely to be adherent to avoid such negative effects. Pharmacists must stress that even if a patients are feeling well and does not physically feel sick, they must continue to take their medications. This challenge arises with disease states like hypertension or mental illness where the person may feel fine after taking their medication for a while and then discontinue there medications thinking that they are now cured.
Financial Constraints. An estimated 14 million Americans with chronic medical conditions cannot afford their medications. Doctors may not consider the price of a drug when prescribing and as pharmacists, we are at the point of care when a patient must make the difficult decision to pay for this month’s supply of medication or food for their family. Pharmacists must take due diligence to discover whether their patients are adherent as result of financial hardship. It can be a difficult subject to approach, but there are some questions that can be asked to indirectly ascertain this information; examples of such questions include: “Are there circumstances that make it difficult to fill your prescriptions?" or "Are you testing blood glucose less often because you're trying to conserve supplies?" If it is discovered that a patient cannot afford their prescriptions, we as pharmacists could contact the prescribing physician and request a generic alternative or contact the pharmaceutical company for possible discount/assistance programs. Medication adherence is a significant barrier to achieving positive therapeutic outcomes in our patients, but there is a tool that has been developed over the last several years that will make the task of overcoming these barriers much more attainable.
Medication therapy management (MTM) was developed in response to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. MTM provides pharmacists the unique opportunity to be the ‘medication expert’ and improve patient adherence, and thus outcomes. With pharmacists now becoming more integral in the health care team, and being able to interact with patents in a more prominent role, we are now in a great position to correct the factors that interfere with a patient being adherent. By using tools like the interview a pharmacist can glean valuable information from their patient and make adjustments when necessary before the patient is potentially harmed. Communication and information gathering are valuable in improving overall outcomes and MTM gives pharmacists the necessary means to not only communicate but do something about it.
It is our role as pharmacists to communicate, educate, and in turn ensure that our patients take their medications as prescribed. We’ve discussed why a patient might not take their medications and how to counter such obstacles to adherence as well as the ever evolving role of MTM in healthcare.
Mackenzie F. Blair, PharmD ‘15