43 posts categorized "Medication Adherence"

03/01/2016

Can technology stop drug prices from rising?

There has been a well-documented trend toward higher drug prices in the US. Turing Pharma turned heads by raising the price of Daraprim® by 5,000 percent, and there has been more news coverage of the practice of hiking drug prices. At the same time, new technologies and group purchasing power are being harnessed to counteract this trend. These two competing forces will help shape the ongoing debate on drug pricing.

In early February 2016, Blink Health announced the launch of its mobile app and website, purposed to help consumers secure the lowest possible retail price. Blink is not a retail pharmacy, but it works with MedImpact, a pharmacy benefits management company affiliated with 60,000 pharmacy locations. Users can supposedly get better prices on generics, because Blink can use its group purchasing power to negotiate lower prices. The app and website quote a price, which the user pays prior to going to the pharmacy. He/she still must provide a prescription to the retail pharmacy, but the price is secured for any of the affiliated locations.

Blink claims that users can save 80% on generics; that 40% of its medications cost less than $5; and, that 50% of its medications cost less than $10. The company claims that higher prices cause patients to skip doses and to stop the regimen entirely. They claim that their tool will help increase access to medications through lower prices.

Navigating drug pricing is notoriously labyrinthine. Most retailers do not post their prices and prices vary for different consumers and consumer types within the same market. Lisa Gill, deputy editor of Consumer Reports Best Buy Drugs is quoted by the NY Times saying, “The prices are all over the map, even within the same ZIP code.”

Since 2006, Wal-Mart, the world’s largest retailer, has been providing certain generics for $4 for a 30 day prescription. The company maintains a list of drugs that it provides at that price. The company provides this price by using its purchasing power, and by taking advantage of its distribution system. There are other programs, such as GoodRX, that aim to provide patients the lowest possible prices on generics. GoodRX is similar to Blink Health, but it provides coupons to be used at the retail site. Blink allows patients to pay for the drug prior to picking it up at one of the affiliated pharmacies.

Brand name drugs fall outside of the scope of these programs. In addition, generic drugs like Daraprim®, which is a sole-source product, will not likely be affected by these and similar price control programs. However, Wal-Mart, Blink, GoodRX and others are applying downward price pressure to the market for generic drugs. Whether this is sufficient to keep prices under control, overall, is yet to be seen. The companies leverage technology to secure lower prices. Consumers demand lower prices, and these services will survive and profit if they provide value to consumers. The prices they offer are closer to the prices paid by insurers.

High drug prices can have a deleterious effect on patient behavior. As Blink Health has claimed, higher prices often discourage patients from filling out prescriptions and often push them to skip doses. Tools that help patients secure drugs at lower prices, even if only in retail settings, should have a positive effect. A case can be made that these tools address only the symptom of higher prices and not the causes. Factors that drive up prices may be ignored, since these tools provide lower prices as an end result. Drug companies can refuse to address higher prices by pointing to these tools as proof that their drugs are ultimately affordable.

The ongoing drug price debate, fueled by Turing’s move and others, highlights the high cost of prescription medications. The new tools take advantage of the information gap between consumer and producers. They do provide a valuable service, although the debate continues. Should there be price controls on critical drugs? Should the US move to a single buyer system, as is the case in Canada and European countries? If so, Blink, GoodRX, and other similar businesses will be impacted, since they would be unable to provide lower prices than that set by the government.

Magdi Stino, Health Policy PhD Candidate

10/20/2015

Daraprim – The Ultimate Drug Pricing Outrage?

Drug priceBy Dr. Daniel A. Hussar, the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter from which this editorial was taken.

Pyrimethamine (Daraprim) was initially approved in the United States in 1953 for the treatment of patients with malaria. It was subsequently determined to be of value in the treatment of toxoplasmosis, a relatively uncommon but sometimes fatal parasitic infection for which patients with compromised immune systems (e.g., patients with AIDS) are at greatest risk. Pyrimethamine is a component of the regimen that has been considered to be the most effective treatment for toxoplasmosis.

Pyrimethamine was originally developed and marketed by the Burroughs Wellcome Company (subsequently acquired by the company now known as GlaxoSmithKline). Following expiration of its patent, the product and its trade name Daraprim have been acquired and marketed by several other companies. Generic formulations of the drug have either been unavailable or available on only a limited basis because the drug is used so infrequently that generic companies have not considered it commercially feasible to market. As recently as 5 years ago, the cost of Daraprim was about $1 a tablet. The US marketing rights to the drug in the United States were sold by GlaxoSmithKline in 2010, and the rights to the drug have been sold several additional times during the last five years. In the period preceding August, 2015 Daraprim was marketed by Impax Laboratories at a cost of $13.50 a tablet.

Turing Pharmaceuticals

In August, 2015 Impax sold Daraprim to Turing Pharmaceuticals. Shortly prior to that time Impax discontinued distributing the drug through the traditional pharmacy system and restricted its availability to a controlled distribution system, resulting in only very limited supplies of the drug remaining available in general distribution.

The CEO of Turing is a former hedge fund manager and a former CEO of a small pharmaceutical company (Retrophin), another company that acquired an older infrequently prescribed drug (tiopronin [Thiola] for the prevention of cystine kidney stones) that was not available from other sources, and then markedly increased its price.

Following its purchase of Daraprim in what has been described in commentaries as an "overnight" price increase, Turing raised the price of Daraprim from $13.50 a tablet to $750 a tablet. The company and its CEO initially attempted to justify the price increase by describing it as a great business decision that would be of benefit for all of its stakeholders. The previous price was identified as unprofitable and the drug was portrayed as being so infrequently prescribed that the impact of the price increase would be minuscule. The Turing CEO was quoted as saying, "This isn't the greedy drug company trying to gouge patients, it is us trying to stay in business" (New York Times, September 20).

Outrage!

Daraprim is not the first drug for which the availability of an older drug has been limited/restricted/controlled with a resultant sharp increase in its price. Examples include tiopronin, doxycycline, cycloserine, isoproterenol, repository corticotropin injection (H.P. Acthar Gel), and hydroxyprogesterone caproate (Makena). However, the outrage regarding the Daraprim price increase from patients, health professionals, legislators, Presidential candidates, and the public has been immediate and intense. This response is certainly due, in large part, to the huge amount of the price increase, profit being the single motivation for the increase, and the arrogance of the company and its CEO in attempting to justify the increase. This situation has also occurred during a time period in which numerous concerns have been voiced about the prices of many drugs, including important drugs for chronic hepatitis C infection, cholesterol-regulating drugs with a unique mechanism of action, and many anticancer drugs.

The Daraprim experience has become a "lightning rod" that has galvanized attention to all examples and reasons for which many have concerns about drug prices. It has to be the worst nightmare for the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Biotechnology Industry Organization (BIO) that represent the interests of the pharmaceutical companies, and are very concerned that their member companies' motives and actions might be considered to be similar to those demonstrated by Turing. BIO issued the following statement in response to the Daraprim situation:


"Turing Pharmaceuticals was a member of BIO for a brief period of time and is currently no longer a member. The company and its leadership do not reflect the commitment to innovation and values that are at the core of BIO's reputation and mission. For that reason, BIO determined, after a review of Turing's membership status, that the company did not meet our eligibility criteria, and we took action to rescind its membership and return its membership dues."

I commend BIO for taking this action. However, an evaluation of "the commitment to innovation and values" of certain other companies is also warranted. Although the price increase and statements from Turing may be the most blatant and arrogant to date, some other companies are also engaged in similar practices that are motivated only by the anticipation of large profits.

The storm of criticism and anger regarding the price increase for Daraprim resulted in an announcement from Turing several days later that it would lower the price although, at the time this is being written, the reduced price had not yet been identified. Turing also attempted to convey a message that the higher price was needed to fund research regarding toxoplasmosis and the development of educational programs and new drugs from which patients would benefit. It also indicated that the medication would be provided to patients with financial need. However, its singular motivation for high profits had already been exposed, and its belated attempt to claim it was interested in patients only further eroded its credibility.

A better outcome

The antitubercular drug cycloserine was developed in the 1950s but is seldom used in current therapy. However, it is of value in the treatment of patients with potentially life-threatening multi-drug resistant tuberculosis that is resistant to conventional antitubercular regimens. Cycloserine capsules have been supplied by The Chao Center, a nonprofit organization that is part of the Purdue Research Foundation, at a cost of $480 for 30 capsules. It recently sold the product to Rodelis Therapeutics. When it was learned that Rodelis planned to increase the price of cycloserine to $10,800 for 30 capsules, Chao requested that the rights to the drug be returned. The two companies agreed that the sale of the drug would be canceled and the rights to the drug were returned to Chao. Although Chao considers it necessary to raise the price to approximately $1,050 for 30 capsules, this is only about one-tenth of the price Rodelis had planned to charge.

Other options

The Daraprim experience represents an abuse of the drug distribution system and undermining of its already fragile financial viability. These situations must not be tolerated. One strategy is to have the company that initially obtained approval for the drug or a generic pharmaceutical company supply the drug at a low profit margin. The situation described above in which cycloserine is supplied by a nonprofit organization is a variation of this approach.

Another option is to have compounding pharmacists obtain the medication and prepare the appropriate dosage forms. Although there are restrictions with respect to pharmacists compounding formulations that are commercially available, this situation needs to be reconsidered and exceptions to the restrictions explored.

Another option is to obtain certain medications from a Canadian pharmacy. I have not been an advocate for US residents obtaining medications from Canada and other countries. However, it is my understanding that pyrimethamine tablets cost between $6 and $7 each from a Canadian pharmacy, compared to $750 that Turing was planning to charge in the US. This difference can't be justified and current restrictions must be reconsidered.

The concerns about the prices for new drugs and other drugs that still have patent protection are complex and beyond the scope of this commentary. However, for older drugs for which the patents have expired, the options identified above should be actively pursued to prevent greedy profiteers from exploiting the drug distribution system by restricting availability and charging astronomical prices. Pharmacists, other health professionals, and patient groups must work with legislators and the Food and Drug Administration to remove restrictions that currently limit the extent to which affordable medications can be provided for patients.

09/30/2015

Alum's Pharmacy Nationally Recognized for its Service to Community

HealthMart_Tepper_093015Pharmacy alumnus Craig Lehrman P’89, a second-generation pharmacist who learned the business from his father, was recently honored for consistently providing care and services that add measurable value to patient healthcare and community wellness. His independently-owned Tepper Pharmacy, located in Wynnewood, Pa., is one of 10 pharmacies across the country to receive the Health Mart Community Healthcare Excellence Award.

After graduating from Philadelphia College of Pharmacy in 1989, Lehrman gained most of his pharmacy experience working for others before he achieved his goal of owning a pharmacy in 2011. Over the past four years, Lehrman and his staff have continued to build upon Tepper Pharmacy’s rich 30-year history of delivering personalized care to the community.

“I was interested in the business aspect of pharmacy, but it was my father that guided me into the profession of pharmacy,” he said. “I was looking for a store to buy and even considered opening a new store from scratch, until the perfect opportunity arose to take over Tepper Pharmacy.”

In this new era of chain pharmacies and mail order prescriptions, one of the hallmarks of independent pharmacies, like Tepper, is their ability to understand and cater to the unique needs of their community.

“I want the service that we provide to make us unique,” Lehrman said. “The personal interactions we have with our customers is what makes us stand out and it is an important part of what makes Tepper Pharmacy a successful business.”

Beyond the traditional services most pharmacies offer, Tepper Pharmacy’s staff includes an employee who specializes in fittings for compression stockings and sleeves and is also an expert in durable medical equipment and wound care, a pharmacist who specializes in managing the medications for long-term care facilities in the area, and a pharmacy team that services local dialysis centers.

To help the community stay healthy, Tepper Pharmacy administers vaccinations, offers free delivery anywhere in the Philadelphia metropolitan area, and makes every attempt to fill all prescriptions by stocking a large inventory. These specialized and personalized services are just a few examples that exemplify the concern Lehrman and his pharmacy staff have for the community.

The Health Mart Community Healthcare Excellence Award program is a component of the Health Mart Healthy Living Tour, which is on the road to celebrate and recognize community pharmacists for the important role they play as trusted healthcare providers in their communities—helping to educate and counsel on a variety of conditions that can be better managed with the help of a pharmacist.  

“Health Mart pharmacies fill a gap in today’s busy healthcare system by providing broader access to clinical services and medication counseling, and our pharmacists often serve as the first point of care for everyone from new parents to grandparents,” said Chuck Wilson, vice president of Health Mart. “We recognize that issues like diabetes and obesity are serious epidemic affecting millions of Americans, and these 10 pharmacists have proven themselves as go-to resources for those in their community managing these diseases.”

07/21/2015

Jamaican a Difference: PCP Students Complete Interprofessional Medical Mission Trip

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Left to right: Pharmacy students Joellen Friedman, Brie Kassamura, Nitin Bagga, Julian Kam, Grace Park and Monika Cios.

Pharmacy student Nitin Bagga PharmD'16 observed closely as a middle-aged Jamaican woman—with teeth rotted well into her gum line—underwent an oral exam at a free health clinic in Kingston. Until that day, the woman had no means of getting medical attention or hope that the pain would come to an end.

Stories like this highlighted all of the reasons why nearly a dozen pharmacy students and professors from University of the Sciences made the journey to Jamaica last month to participate in an interprofessional medical mission trip.

It was a mission to help others, to learn about a culture 1,500 miles from Philadelphia, to gain work experience, and to come away better people. It was a mission to give back.

“This trip was a humbling experience to say the least…seeing the poverty in different parts of the world and being able to help so many in need was extremely rewarding,” said Bagga. “Working with the different healthcare professionals on the trip has prepared me to be the best pharmacist I can be.”

Bagga was accompanied on this trip by his classmates Joellen Friedman PharmD’16, Brie Kassamura PharmD’16, Julian Kam PharmD’16, Grace Park PharmD’16, and Monika Cios PharmD’16; and pharmacy professors Drs. Shelley Otsuka, Jessica Adams, and Yvonne Phan.

The pharmacy group from USciences joined a large team of healthcare practitioners and professional students from Nova Southeastern University and Women of Health Occupation Promoting Education (H.O.P.E.) to provide essential medical services to Jamaicans in critical need of quality medical and dental care, health awareness education, and pediatric care.

By the end of the trip, the team had provided care to more than 3,000 patients at prisons, churches, schools, and hotels across rural and urban communities in Jamaica. In fact, the USciences pharmacy team filled more than 5,000 prescriptions for these patients.

The Philadelphia College of Pharmacy students had many responsibilities before, during, and after the mission trip, said Dr. Otsuka. They prepared for the trip by updating the medication guide-use tools, reviewing the medication formulary, developing patient education pamphlets, creating a continuing medical education presentation handout, and constructing a research project that included a protocol. In addition, they held disease-state topic discussions with their instructors to help review treatment guidelines.

MissionTrip
Joellen Friedman PharmD’16 provides patient counseling to a mother and her young daughter.

The students also collected donations from pharmaceutical companies, alumni, and local businesses, such as SunRay Drugs and ACME Savon Pharmacies. As a result of their efforts, approximately 75 different medications were used to treat a variety of patient conditions in Jamaica. They also held fundraisers in the spring to offset their housing expenses for the trip and to raise money to purchase medical supplies, including gloves, hand sanitizer, and Ziploc bags—which functioned as the medication vial.

During the trip, the students had the opportunity to work alongside healthcare practitioners and students in the fields of medicine, physical and occupational therapy, and dentistry. They also managed a closed formulary system and maintained an accurate medication inventory system, as well as filled, compounded, and labeled medications, and counseled patients on new medications—all under the guidance of their professors.

When the students returned to Philadelphia, Dr. Otsuka said they took stock of their inventory, wrote self-reflection essays, and gathered and analyzed data for a scholarly project. She said they plan to submit an abstract and research poster for the American Society of Health-System Pharmacists' Midyear Clinical Meeting, and share their experience with peers and underclassmen this fall.

Throughout the trip, each healthcare profession interacted with pharmacy in a unique and collaborative way, said Park.

“Pharmacy was truly an equally integrative part of the healthcare system and care of the patient,” Park said. “Being able to be a part of that and see it occur in one room was an unforgettable experience.”

CLICK HERE TO SEE A PHOTO GALLERY FROM THE TRIP

12/05/2014

Medication Adherence and Hospital Readmissions

Whether patients are getting medications, seeing a primary care provider, discharged from a hospital, or getting emergency care, they are being shifted between different health care providers. Transitions of care is an important aspect of healthcare because it allows smooth movement of patients from one setting to another.

Transitioning from the hospital to home can be difficult for patients, potentially leading to readmission if the transition is not well coordinated. Kirkham conducted a retrospective cohort study in two acute care hospitals in the United States to see the effect of a collaborative pharmacist-hospital care transition care program on the likelihood of 30-day readmission rates. The two-year study showed patients who did not receive bedside delivery of post discharge medications and follow-up telephone calls were twice as likely to be readmitted within 30 days of discharged than those who did receive these services. For patients greater than 65 years of age, the pharmacist transition of care resulted in a six-fold decrease in 30-day readmission rates. As this study shows, a transition of care program can be associated with a lower likelihood of readmission and pharmacist participation can be of significant benefit.  

A study conducted by Bellone reviewed 131 patients aged 18 to 65 on at least three prescription medications. The intervention group consisted of patients that pharmacists visited within 60 days of discharge to provide medication counseling or dosage adjustments, while the control group did not receive any intervention. The intervention group had an 18.2% hospital readmission rate compared to 43.1% in the control group (P = 0.002).  Pharmacists can optimize medication adherence during transitions of care to reduce readmission rates. The American Pharmacist Association and American Society of Health-System Pharmacists released a Medication Management in Care Transitions Project to display popular models from across the country that improve patient outcomes by involving pharmacists in medication-related transitions of care. Some of the roles and responsibilities of pharmacists in these practices include: medication reconciliation, counseling on medication therapy, contacting the patient’s home for follow-up, preparing medications etc. Through these interventions pharmacists are involved in patient care from inpatient to home settings.

Transition of care pharmacists can be a beneficial aspect in the health care system. By providing appropriate interventions, pharmacists can decrease the likelihood of hospital readmission.

Urvi Patel, PharmD ‘16

11/21/2014

Medication Adherence In Patients with Depression

Depression is a mental disorder that has an unknown cause. There are many explanations for developing depression including genetic, biological, environmental, and psychological features. Signs and symptoms of depression vary from minimal to severe. Indication that someone may need medication to regulate his or her mood include the following symptoms: persistent sadness, hopelessness, fatigue, irritable mood, loss of interest, feelings of guilt, difficulty concentrating, insomnia, and suicidal thoughts.

There are a variety of classes of medications used for depression, but they all need to be given an adequate trial of about twelve weeks to see if the medication is efficacious. Roughly fifty percent of patients prematurely discontinue antidepressant therapy.  There are serious outcomes if medication is not taken including suicide. A systemic review by Chong evaluated the impact of education and behavioral interventions on antidepressant medication adherence and depression disease progression. This review showed patient education alone did not improve medication adherence rates; however, when used with behavioral changes and multifaceted interventions, adherence rates and depression outcomes improved. Behavioral and multifaceted interventions include education, telephone follow-up, medication support, and communication with primary care providers. For this reason, it is crucial to have pharmacist intervention when dealing with antidepressants to provide proper counseling on the medication to lead to better insight on the medication as well as intervene on proper behavioral changes.

Pharmacists can help increase outcomes of depressed patients by counseling them on their medication. Antidepressants are different than other medications because they need a longer period of time to feel it working. This presents as an issue for patients because they do not feel the need to take a medication that is not helping them feel better instantaneously. Also, patients might think they do not need a medication if they are starting to feel better.  Pharmacists should explain to the patient that it takes antidepressants at least two weeks to take effect. Patients should also be informed that there are common side effects associated with these medications and it is important to continue taking antidepressants for at least six to nine months to prevent reoccurrence of depression.

Because there are many negative side effects of depression, it is important to manage it with appropriate medications. Due to their expertise on antidepressants, pharmacists can counsel patients on what to expect, the onset of action, and duration of use for these medications. Through patient education, behavioral changes, and multifaceted interventions patients can have better outcomes for their depression.

Urvi Patel, PharmD 2016

11/12/2014

Medication Adherence In Hypertension Patients

Hypertension, also known as high blood pressure, does not usually present itself with symptoms. However, it can be deadly if not treated properly. Through time, 78 million Americans have been diagnosed with hypertension. High blood pressure occurs when the force of blood is high causing the arteries to stretch and damage, which can lead to severe complications such as heart attacks. To prevent cardiovascular events, it is important to chronically treat hypertension. With increasing number of patients getting this disease, it is key for patients to stay educated, monitor blood pressure, and adherent to their diet and medication regimen.

According to the Health Belief Model (HBM), there are certain aspects that tell whether a patient will take their medications. Some barriers to adherence include patients perceived susceptibility and severity of the disease. If patients do not think they are going to get a disease or the disease does not impact their quality of life, they may not be adherent to medications. Patients have a call to action, such as taking medications and staying adherent, when there is a perceived threat of the disease. Another hindrance of medication adherence would be the patient’s perceived benefits of taking medications minus the barriers or side effects that comes along with it. This HBM can help pharmacists understand patient non-adherence and allow them to better approach to medication therapy management.

A systematic review in the Health Psychology Review by Jones identified intervention studies used by the health belief model. From 18 studies evaluated, 78% of the studies suggested significant improvements in adherence with behavior change interventions. The health belief model is a way to promote behavior through interventions in a variety of disease. The HBM can be applied to hypertension through the help of pharmacists. Researching how much education patients have about the disease will allow pharmacists to gauge how well patients understand the disease. Knowledge of the disease can be assessed through questionnaires. Through these surveys, pharmacists can learn about the patient’s lifestyle to construct the best regimen.

The prevalence of hypertension will decrease dramatically when pharmacists incorporate the HBM into counseling patients.  By understanding the HBM, our society can better the symptoms of hypertension.

 

Urvi Patel, PharmD ‘16

10/30/2014

Chronic Medication Adherence: Diabetes

Diabetes is a chronic disease that affects millions of Americans. It is a group of metabolic disorder characterized by persistent hyperglycemia. Early diagnosis and proper treatment is important to reduce complications such as coronary artery disease, blindness, and loss of sensation. However, as stated by Dr. C. Everett Koop “Drugs don’t work in patients who don’t take them.”

Diabetes is one the leading causes of death. It is very important to eat a healthy diet especially with this disease. Patients who have diabetes should be encouraged to modify their diet to include more vegetables, whole grains, fruits, non-fat dairy products, beans, lean meats, poultry, and fish. A study done to see the correlation of self-monitoring of blood glucose to weight loss by doing a weight loss intervention showed increased self-monitoring of blood glucose and greater weight loss was achieved through better adherence to diet. The authors concluded self-monitoring of blood glucose leads to increased adherence to diet. Also, patients that were educated about the impact of diet on weight loss, showed increase adherence to diet and better glucose control.

A retrospective literature search was conducted by Cramer to assess the adherence to oral hypoglycemic agents and insulin products and its effect on glycemic control in diabetes patients. In this systematic analysis, she found that electronic monitoring was effective in identifying patients who were poorly adherent.   The study showed that electronic monitoring systems can be used to increase adherence by providing health care providers the information needed to identify patients than need interventions.

Pharmacists today use electronic monitoring through computerized programs that measure adherence rates such as refill rates. There are many ways pharmacists can intervene to increase adherence rates with chronic medications, such as oral hypoglycemic medications. Non-adherence can be detrimental to patients, so pharmacists can intervene by counseling newly diagnosed individuals of the benefits of taking their medication properly and the risks that may occur if medication is not taken. Also, pharmacists can review adherence rates with patients to identify reasons why patients may not be taking their medications. If patients cannot tolerate certain medications, or cannot follow directions appropriately, pharmacists can suggest other products.

The cost of not taking medications is high in patients with chronic medications, so it is important that pharmacists and patients work together to create a regimen that is most beneficial.

 

Urvi Patel, PharmD’16

Chronic Medication Adherence: Diabetes

Diabetes is a chronic disease that affects millions of Americans. It is a group of metabolic disorder characterized by persistent hyperglycemia. Early diagnosis and proper treatment is important to reduce complications such as coronary artery disease, blindness, and loss of sensation. However, as stated by Dr. C. Everett Koop “Drugs don’t work in patients who don’t take them.”

Diabetes is one the leading causes of death. It is very important to eat a healthy diet especially with this disease. Patients who have diabetes should be encouraged to modify their diet to include more vegetables, whole grains, fruits, non-fat dairy products, beans, lean meats, poultry, and fish. A study done to see the correlation of self-monitoring of blood glucose to weight loss by doing a weight loss intervention showed increased self-monitoring of blood glucose and greater weight loss was achieved through better adherence to diet. The authors concluded self-monitoring of blood glucose leads to increased adherence to diet. Also, patients that were educated about the impact of diet on weight loss, showed increase adherence to diet and better glucose control.

A retrospective literature search was conducted by Cramer to assess the adherence to oral hypoglycemic agents and insulin products and its effect on glycemic control in diabetes patients. In this systematic analysis, she found that electronic monitoring was effective in identifying patients who were poorly adherent.   The study showed that electronic monitoring systems can be used to increase adherence by providing health care providers the information needed to identify patients than need interventions.

Pharmacists today use electronic monitoring through computerized programs that measure adherence rates such as refill rates. There are many ways pharmacists can intervene to increase adherence rates with chronic medications, such as oral hypoglycemic medications. Non-adherence can be detrimental to patients, so pharmacists can intervene by counseling newly diagnosed individuals of the benefits of taking their medication properly and the risks that may occur if medication is not taken. Also, pharmacists can review adherence rates with patients to identify reasons why patients may not be taking their medications. If patients cannot tolerate certain medications, or cannot follow directions appropriately, pharmacists can suggest other products.

The cost of not taking medications is high in patients with chronic medications, so it is important that pharmacists and patients work together to create a regimen that is most beneficial.

 

Urvi Patel, PharmD’16

10/15/2014

Community Pharmacy Medication Adherence

Medication adherence is a growing concern for health care providers. For this reason many community pharmacies are focusing on was to increase medication adherence rates. This can be done in various ways ranging in diverse settings.

            Medication therapy management (MTM) are services provided by pharmacists to increase therapeutic outcomes. There are approximately 1.5 billion preventable adverse effects that cause $177 billion in injury and death. A major target for MTM occurs in community pharmacies. The Pennsylvania Project studied 107 Rite Aid pharmacies that trained pharmacist to perform interventions including asking questions about medication adherence and 111 control pharmacies that did not perform these interventions.  The endpoints of this study showed an increase in medication adherence (PDC >80%) in the intervention group over the control group.  There was a significant increase in adherence of 3.1% for beta-blockers and 4.8% of for anti-diabetic drugs.

            Patient counseling is a great way for community pharmacists to change medication adherence rates. In an internal study, Walgreens Pharmacy is creating a way to identify patients that may need a little more help with medication adherence by examining  poor past medication adherence rates or new medications prescribed. In a study across 76 Walgreens, these interventions showed an increase in medication possession ratio.

            Chronic medications can be difficult to control of especially if a patient is taking multiple medications. An AHRQ tool used in community pharmacies called refill reminders, can help patients pick up their medications on time.  Using this script as part of an automated reminder system, can help prompt patients to refill their prescriptions or pick up their medication.

            While at work, I have come across these methods to increase medication adherence in the community setting. It is important as pharmacist to intervene early by educating and counseling the patient, so adherence rates start off high. These methods have proven extremely beneficial in my place of work. For example, automatic courtesy refills allow all patients on maintenance medications to be reminded to pick up their medication, so they do not miss doses. These are just some examples of methods being implemented in community pharmacies to help pharmacists identify these patients and improve medication adherence.

Urvi Patel, PharmD ‘16

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