'Multifaceted strategies' can improve medication adherence among patients

From top: Pharmacy Quality Alliance's David Nau and Rite Aid's Rick Mohall discuss medication adherence at NACDS' Pharmacy and Technology Conference.

SAN DIEGO Improving medication adherence will require bringing multiple methods together in order to be successful, Pharmacy Quality Alliance senior director for research and performance measurement David Nau said Tuesday in an education session at the National Association of Chain Drug Stores’ Pharmacy and Technology Conference in San Diego.


“You need to have a multifaceted strategy around adherence if you want to have an impact on adherence,” Nau said.



According to last year’s study by the New England Healthcare Institute, poor medication adherence increases medical costs by up to $290 billion. The estimated one-third of patients who do not take their medications properly fail to do so for a number of reasons, which Nau boiled down to five social-economic, patient-related, therapy-related, condition-related and healthcare system-related factors, including costs of medications, fear of side effects and dependence, complexity of regimens, comorbidities and lack of incentives.



Complexity of medication regimens can be a particular problem for patients with chronic conditions. According to a study of patients using statins for cardiovascular disease, the average user studied took 11 medications, including nine maintenance medications, and often had to visit multiple pharmacies and had multiple prescribers; 10% of statin users studied took 23 or more medications. But according to another study, conducted by Harvard University and CVS Caremark, patients demonstrated greater adherence when they synchronized their refills and were able to fill all their prescriptions at one pharmacy.



All these factors mean that combating nonadherence requires a number of different approaches rather than simple interventions, Nau said. “It’s not just about counseling; it’s not just about slashing co-pays -- it’s about having a multifaceted strategy,” he said.



Future trends that could affect adherence include deals between drug companies and pharmacy benefit managers, integration of medication reminders into social networking sites and medication-delivery technologies allowing delivery of multiple drugs in one pill, or implants that automatically administer doses. The last trend already is under way, to an extent, with the introduction of combination drugs for hypertension, such as Novartis’ Tekamlo (aliskiren and amlodipine besylate), which the Food and Drug Administration approved in late August.



Following Nau’s presentation, Rite Aid director of clinical services Rick Mohall took the stage to show some of the retail pharmacy chain’s adherence programs, such as automatic refills, reminder calls, medication therapy management and the Wellness+ rewards card. “Generally, what’s good for the patient is good for the pharmacy as a business,” Mohall said.



Both presenters emphasized the role of pharmacists in solving the nonadherence problem, with Nau citing a study from this year showing that physicians are “rather ineffective” in promoting medication adherence. “The greatest intervention tool, the thing that all these things need to point to, is the pharmacist,” Nau said.


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