Here’s a shocking statistic: half of the roughly 4 billion prescriptions dispensed by U.S. pharmacies are not taken as prescribed, according to The New England Journal of Medicine, which blames the problem for 33% to 69% of all medication-related hospital admissions. Nonadherence is also linked to some 125,000 deaths every year in the United States.
The impact of poor medication adherence is so severe that the World Health Organization reports that more health benefits would result from boosting adherence to existing drug therapies than would come from the development of any new medical treatments. What’s more, notes a report on medication adherence from Duke University Medical Center and the National Consumers League, “Most patients do not understand their diseases or the consequences of not adhering to a medication regime. Interventions that stimulate better adherence to essential medications even slightly may meaningfully improve public health.”
One prime setting for those interventions, of course, is the pharmacy counter, where contacts between patients and pharmacists and pharmacy technicians are a fundamental part of the prescription dispensing process. Pharmacy techs are often the last point of contact patients have with any healthcare worker before they begin their drug therapy, and the techniques techs use at the pharmacy counter or window to encourage patient adherence to medication regimens could have a real impact on both successful health outcomes and on cost savings to health plans and patients themselves.
The cost savings for boosting adherence rates could run into the hundreds of billions of dollars. “As an example of the cost-saving benefit of medication adherence, it is estimated that for every additional dollar spent on adhering to a prescribed medication, medical costs would be reduced by $7 for people with diabetes; $5.10 for people with high cholesterol; and $3.98 for people with high blood pressure,” noted the Duke University report. “In addition to more obvious costs, such as healthcare expenses, nonadherence may lead to other undesirable outcomes, including patient and physician frustration, misdiagnoses and in more extreme situations unnecessary treatment and exacerbation of disease or fatality.”
Pharmacy staff, including techs, can draw on tools to help them improve adherence. The National Consumers League, for instance, offers a program called “Script Your Future,” which provides tools both for patients and for health providers, including online resources like text message medication reminders, charts to keep track of medicines, a how-to video on using an inhaler, and advice for pharmacy staff and other health workers to encourage patient adherence, at ScriptYourFuture.org.
Adherence and compliance are often thought of as identical terms, but nonadherence can refer to several types of breakdown in patients’ behavior regarding their drug therapy, according to Chris DuPaul, director of strategic development for CVS Caremark. Patients are noncompliant when they take less than the prescribed amount of his or her medication than directed; they’re nonpersistent when they simply stop taking their prescription medicine without consulting the prescribing physician.
Nonfulfillment occurs when a patient never even picks up a new prescription. “When a patient is given a prescription from their prescriber, about 30% of the time, it does not make it to the pharmacy,” noted Nimesh Jhaveri, executive director of pharmacy and healthcare experience for Walgreens.
What role can pharmacy techs play to help improve adherence on all those levels? They can make a significant impact in several ways, said the Walgreens pharmacy executive.
“The greatest role the technician can play in patient adherence is recognizing when a patient should be referred to a pharmacist,” Jhaveri told DSN Collaborative Care. “The technician interacts with patients often and is trained to pick up on cues from the patient that may indicate an adherence opportunity.”
“For example, a patient may be picking up a prescription and mention to the technician they cannot afford their medication and can no longer take it. In this case, the technician has the opportunity to bring the pharmacist into their conversation to understand their concerns and recommend a possible option,” he said.
“Another way a technician can assist with patient adherence,” Jhaveri said, “is to educate and inform the patient on services we offer,” including Walgreens’ auto-refill program. “In addition, technicians can offer products to assist with adherence, such as pill boxes or calendars.”
The health system’s growing reliance on health information and communication technologies like electronic prescribing could spur patient adherence rates, Jhaveri added. “One way technology is impacting patient adherence is through the use of e-prescribing,” he noted. “With e-prescribing, it is a certainty that a patient’s prescription arrives at the pharmacy. Having the prescription at the pharmacy provides an opportunity for the technician to call the patient if they do not pick up their prescription.”
Jhaveri predicts, “The role of the technician will continue to grow as the use of technology continues to expand. As technicians become freed up through the use of technology, they may have more free time to spend and communicate to their patients.”