With half of all patients not taking their medications as prescribed, efforts to engage patients more effectively and boost adherence rates have become critical for pharmacy leaders. Here, we discuss how CVS Caremark is addressing the challenge with William Shrank, M.D. the company’s chief medical officer for provider innovation and analytics. Shrank recently spoke at the 2nd Annual World Congress Summit to Improve Adherence & Enhance Patient Engagement, sponsored by MWV Healthcare.
DSN: What do you see as the chief barriers to adherence?
William Shrank, M.D.: Nonadherence to medications is a multi-faceted issue. Barriers may vary from patient to patient. We also believe the patient’s family and friends can play an essential role in promoting adherence. We want to be sure adherence is a team sport, and not an individual one.
In our research we have seen that some of the key barriers to adherence include cost, convenience, forgetfulness, complexity of the patient’s treatment regimen and sometimes even the patient’s access to a social support system, either through family caregivers or more formal patient support.
Overall, the decision to take or fail to take a medication is very personal. We need to leverage our extensive data assets, as well as our personal relationships with patients, to carefully target the right intervention to the right patient.
DSN: What interventions with patients are proving most effective at improving adherence rates at CVS?
Shrank: We conduct peer-reviewed research and have been leveraging those learnings to identify, develop and pilot breakthrough innovations. They range from developing models to predict a patient’s adherence behaviors in order to better target interventions, to using medication reminder devices to help combat forgetfulness and to digital interventions that engage patients to encourage adherence. This research will help develop best practices for the entire field, and help us engage in new and more productive ways to encourage better adherence.
Our research has shown that pharmacists are among the most effective health providers in encouraging medication adherence among patients. Our Pharmacy Advisor Counseling program engages patients with chronic conditions face-to-face or on the phone with our pharmacists to improve adherence and identify gaps in care.
DSN: You have said that pharmacists can be more effective than physicians at improving adherence. How are health information technology, electronic health records, e-prescribing, data mining, mobile app refill reminders and other technologies providing new windows into patient behavior and aiding CVS in that effort?
Shrank: Many patients see their pharmacist more often than their doctor, and that face-to-face interaction and counseling can provide important insights as to why a patient isn’t adherent and how to address their issues. We’re engaged in a number of pilots to determine how best to leverage technology and digital tools to improve adherence. These include engaging patients through apps and devices to encourage adherence through reminders and incentives; as well as evaluating patient data to develop predictive models to help determine who is more likely to become non-adherent and what interventions may work best for these individuals.
DSN: How far along is CVS in incorporating medication synchronization at its pharmacies as a tool for improving adherence and building an appointment-based patient-intervention model?
Shrank: We are engaged in a medication synchronization pilot to help those patients with chronic conditions dealing with multiple medications. We look forward to sharing concrete results on the impact of this pilot.