Did you know that hospitalization costs due specifically to antipsychotic nonadherence have been estimated at $1.5 billion annually?1
As the healthcare system evolves towards outcomes-based care models, medication adherence metrics directly influence providers’ financial performance, impact reimbursement rates, and are correlated to health outcomes, particularly for those with chronic illness or those struggling with behavioral health challenges.
Unfortunately, people often struggle to take their medication as prescribed. Language barriers, limited access to health education and technology, and socioeconomic factors can all impede adherence efforts. Overcoming these obstacles necessitates a comprehensive and individualized approach that considers the unique circumstances of each person.
Local pharmacies, deeply rooted in their communities, possess a profound understanding of local resources and culture. Unlike their larger corporate counterparts, local pharmacies have the advantage of being at the forefront of results-based care, embracing a personalized approach that extends beyond the mere dispensing of medications. To this end, local pharmacists are uniquely positioned to actively engage with community groups and forge partnerships with local healthcare providers.
Addressing SDoH Barriers Through Engagement
Each individual brings a unique set of circumstances encompassing diverse experiences, cultural factors, and educational backgrounds that shape their healthcare journey.
Take for example Shawn,* a young man who struggled with medication compliance due to financial pressure, minimal medication literacy, and lack of reliable transportation. Without properly taking his medication on a regular schedule, he had trouble regulating his behavior. When Shawn was able to come into the pharmacy, it was a regular occurrence to observe him engaging in extremely paranoid and persecuted self-talk. He experienced run-ins with the law. Then even at a state hospital, traditional methods of medication management were not the right answer for him.
Instead of treating him like any other individual they served, the local pharmacy assigned an intake coordinator to partner with him. She took the time to get to know him and understand the underlying causes of his non-adherence. She first partnered with Shawn’s providers to support him through an intensive on-site program, then, once his medication was under control, she helped him independently manage his medications through education and strip packaging that was delivered on a weekly basis when he moved to live on his own. Additionally, Shawn was given a monthly payment plan so that copays would not be required up front upon delivering the medication. Shawn has reunited with his estranged sister, works a regular job at a local grocery store, can now name what medications he is taking and why, and has been able to move forward with his life.
Individualized onboarding, with its emphasis on treating each person as a unique case and equipping them with tailored resources, represents the most effective approach for those requiring a more personalized and hands-on care experience. Building trust is at the core of this strategy, and it begins with dedicated intake coordination to ensure that specific needs are understood and addressed from the outset. This level of personalized attention can be further extended through the assignment of a dedicated team member responsible for the ongoing coordination of care and monthly management of medications.
Custom Solutions for Complicated Cases
By getting to know their customers as people, local pharmacies can tailor solutions, working with the provider to ensure an individual takes – and continues to take – their medication as prescribed. They will also be more equipped to connect with the patient when medication is not being taken to find out why and work towards solutions. It is essential to include the patient as an integral member in their own care, and these conversations can often be short and uninformative without trust as a key ingredient. Likewise, traditional pharmacy staff can see these conversations as tasks instead of important steps towards improving health outcomes unless they are empowered and inspired by the whole-person care approach. By fostering collaborative relationships and sharing knowledge, both pharmacists and care providers play a crucial role in improving medication adherence.
Consider the case of Chris*, recently discharged from a psychiatric hospitalization. Chris struggled with medication adherence due to forgetfulness, often resulting in double-dosing or missed doses of his medications and missed blood draws required when taking an important antipsychotic, clozapine. The provider was very concerned about adherence, knowing Chris could end up in a worse position without strictly taking the medication as prescribed.
Recognizing the significance of medication packaging as a tool to aid adherence, local pharmacists recommended a packaging program to assist Chris in keeping track of medications. In a packaging program, pharmacists work closely with individuals to assess their medication needs and develop a customized packaging solution. The packaging typically involves individualized compartments or blister packs that separate medications for specific times of the day or week. Each compartment is labeled with the medication name, dosage instructions, and the date and time it should be taken.
Building Habits Through Individualized Packaging
The primary goal of a packaging program is to provide a clear visual representation of the medication schedule, making it easier to remember and follow a medication regimen by building habits. Incorporating features like dated packaging helps people easily track whether they have taken their medications as prescribed, minimizing the risk of missed doses or accidental double-dosing.
The FAME study found that pharmacy interventions in the form of medications dispensed in time-specific packets and pharmacist follow up increased overall adherence, defined as those taking 80% or more of all their medications, from a baseline of 5.0% to 98.7% in elderly individuals with at least 4 chronic medications.2 While such interventions are widely accepted in our industry as being effective at combating non-adherence and improving health outcomes for elderly individuals taking multiple medications, they can also be useful for younger clients who are similarly struggling due to any number of challenges.
This seemingly simple intervention proved transformative for Chris, facilitating consistent medication intake and preventing further hospitalizations. The packaging served as a dated reminder, enabling Chris to ascertain whether he had taken his medication at a particular time. Furthermore, it provided a visual indicator of the remaining supply, aiding in scheduling the regular bloodwork required when taking Clozaril. The example of Chris vividly highlights the profound impact that packaging solutions can have in promoting medication adherence, empowering individuals to take control of their health and well-being.
Packaging programs can be particularly beneficial for anyone with complex medication regimens, serious mental illness, elderly individuals, those with cognitive impairments, or individuals transitioning from a hospital or care facility to living independently. By providing a structured and organized approach to medication management with pharmacist follow up, these programs can enhance safety, improve medication adherence, and ultimately contribute to improved health outcomes, including decreased morbidity and mortality.3
Communicate and Stay Proactive
It is imperative for providers and local pharmacies alike to remain proactive and adaptable. Active engagement, community involvement, and the cultivation of collaborative partnerships are essential. By participating in professional organizations and networking with local providers, pharmacists can stay informed and contribute to the development of new initiatives aimed at enhancing medication adherence.
The commitment to continual improvement and the pursuit of innovative strategies are paramount. As technologies advance and healthcare delivery methods evolve, we must remain open to novel approaches that foster greater engagement and support.
The importance of medication adherence cannot be overstated. Someone taking their medication as prescribed directly impacts outcomes and healthcare costs and reduces the need for future care and emergency services that burden the healthcare system. Pharmacists at local pharmacies have a unique opportunity to provide comprehensive, whole-person care, reinforcing trust and improving overall health outcomes with much more robust solutions than a pharmacist has available to them at a chain pharmacy. These include commitment to individualized onboarding, medication synchronization, monthly check ins and reconciliation of changes, coordination of care with providers, delivery options, flexible financing, and packaging solutions. By understanding the barriers to adherence, tailoring these solutions to individual needs, and actively engaging with customers, we can empower individuals to take control of their health.
Let us embrace the responsibility to actively contribute to our communities, build collaborative partnerships, and continually seek innovative ways to improve medication adherence. Together, we can make a lasting impact, fostering healthier lives and a more resilient healthcare system.
1. Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020, January 16). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966860/
2. Taylor, A. (2006, November 13). Federal study of adherence to medications. American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2010/02/23/19/06/FAME–Presented-at-AHA-2006
3. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Geneva: WHO, 2003. Adh.200×260/0 (who.int)
*Name changed to protect privacy