PHARMACY

NCPIE outlines steps to improve adherence among elderly, polychronic patients

BY Alaric DeArment

WASHINGTON — Calling it a "looming threat," the National Council on Patient Information and Education released a 10-step plan to draw attention to the problem of poor medication adherence among elderly people with multiple chronic conditions.

The report, titled "Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda," found that poor adherence among patients with chronic and comorbid conditions is resulting in disease progression and complications, as well as increased uses of more expensive healthcare services like emergency room visits, hospitalizations, re-admissions and post-acute care. Caring for about 27% of Americans with multiple chronic conditions accounts for 66% of the country’s health expenditures and is a major source of Medicare spending. Patients with six or more chronic conditions accounted for about 14% of the Medicare population and cost $32,658 per patient, or three times the national average, the report found. As a result, the cost of treating them was more than $140 billion, out of $300 billion in Medicare spending overall. Forty-two percent of elderly people took five or more drugs in 2012, with the average number of drugs increasing from five at age 65 years to seven at age 85 years.

"Although the challenge of poor medication adherence has been discussed and debated extensively, what is lacking is the clear recognition that prescription medicine use and the rising prevalence of chronic and comorbid conditions are inextricably linked and together represent a major opportunity to address this health threat," NCPIE EVP Ray Bullman said. "This report is intended as a wakeup call that action is needed now to confront this combined threat, before the continuing upsurge of chronic conditions overwhelms the healthcare system."

The 10 steps that the NCPIE outlined were:

  1. Establish medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.
  2. Establish the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.
  3. Promote clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions.
  4. Incentivize the entire healthcare system to incorporate adherence education and medication support as part of routine care for MCC patients.
  5. Eliminate the barriers that impede the ability of patients with multiple chronic conditions to refill their prescription medicines.
  6. Reduce the cost-sharing barriers for patients by lowering or eliminating patient co-payments for prescription medicines used to treat the most common chronic diseases.
  7. Accelerate the adoption of new health information technologies that promote medication adherence.
  8. Establish medication adherence as a measure for the accreditation of healthcare professional educational programs.
  9. Address multiple chronic conditions and optimal medication management approaches in treatment guidelines.
  10. Stimulate rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.

The NCPIE includes the National Association of Chain Drug Stores, the National Community Pharmacists Association, Cardinal Health, McKesson Corp. and others.

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Study finds widespread nonadherence among schizophrenia patients

BY Alaric DeArment

NEW YORK — Nearly half of patients with schizophrenia don’t comply with doctors’ prescription instructions, according to a new physician survey.

Research firm GfK found non-compliance among 45% of patients, an increase of four percentage points over last year. The most common reasons included dislike of medication, concern about side effects and denial of illness. The overall level of non-compliance has ranged between 41% and 46% since 2009, and 74% of doctors cited dislike of medications as a reason, while 71% cited such side effects as tremors, sleepiness and weight gain.

Depot drugs, which only need to be taken once a week or less, have been the most talked-about new developments in the schizophrenia category, but they have not substantially improved compliance, GfK found. Depot drugs account for roughly one-fifth of all schizophrenia prescriptions, up slightly from last year.

"Drug manufacturers need to address the top unsatisfied requirements among psychiatrists, and even market to those benefits," GfK health team research director Paul Wojciak said. "As more doctors become familiar with the benefits of depot drugs, we may see a shift in how schizophrenia is treated in the coming years."

 

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Independents increase role in promoting adherence, generics

BY Alaric DeArment

ORLANDO, Fla. — Independent pharmacies are focusing more on helping patients adhere to their medication therapies and save money by using generics, according to a new digest for members of a trade group that represents independents.

The National Community Pharmacists Association, in its 2013 NCPA Digest, found that 48% of all community pharmacies offer patients adherence counseling services, up from 39% in the last survey. Meanwhile, the percentage of community pharmacies providing adherence phone calls or text messages increased from 22% to 39%. Independents also dispensed generic drugs 77% of the time; their pharmacists routinely consult with physicians about proper prescription drug therapy, and pharmacists’ recommendations for generic drug use are accepted 83% of the time. The total number of independent pharmacies in the country is estimated at 23,029, from 23,106 last year.

The digest was sponsored by Cardinal Health and is available to NCPA members.

Medication Adherence in America: A National Report Card, released earlier this year, found that on average, Americans ages 40 years and older with a chronic condition earned a C+ on average, while one-in-seven in that group received an F.

"Independent community pharmacists are playing a larger role than ever in improving health and cutting costs through the promotion of medication adherence and proper use of generic medicines," NCPA CEO B. Douglas Hoey said. "The digest reinforces the value and diverse nature of the care provided by trusted, community pharmacists. Small business community pharmacy owners and pharmacists look forward to continuing to work to help policymakers and health plan sponsors enhance patient outcomes and reduce expenses."

Other findings included that a majority of prescriptions came from Medicare and Medicaid — 33% and 18%, respectively — and that 53% of independents are in areas with populations of 20,000 or less, making them an important lifeline for underserved and rural areas.

"Cardinal Health is proud to again sponsor the 2013 NCPA Digest, a comprehensive report to help pharmacy owners make smarter business decisions," Cardinal Health VP retail marketing Ron Clerico said. "We realize that community pharmacists play a unique role in helping improve our nation’s healthcare system."

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