Q&A: Turning to technology with Kristi Rudkin of Walgreens
Following her appearance at the 2nd Annual World Congress Summit to Improve Adherence & Enhance Patient Engagement in Philadelphia, Kristi Rudkin, senior director of product development for Walgreens, spoke with DSN about the company’s efforts to boost patients’ adherence rates. Here are excerpts from that interview:
DSN: What’s your overall impression of the conference? How committed are the participants to improving adherence and patient engagement?
Kristi Rudkin: It was about collaboration, and you could tell there was a path forward from last year’s conference. The detail and depth of the conversation — and what has been learned and tried over the last year — is impressive. I think as an industry we are moving toward being able to solve a good percentage of the adherence problem.
DSN: Adherence dovetails with so many things going on now in pharmacy. Are the health system and community pharmacy on the same page regarding goals like engaging patients and improving adherence?
Rudkin: Yes, I do think many of the stakeholders were on the same page, and much of the discussion was on how we do that collaboratively.
For me, one takeaway from the conference was that … it really will take a village of providers to help solve this adherence problem, with participation from pharmacy providers, health plans and prescribers working together to help solve this problem.
DSN: 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 Walgreens in its effort to improve patient adherence rates?
Rudkin: I definitely believe that. Data mining is critical to understanding patient behavior, and the many ways we can reach people these days through technology — whether a mobile app reminder or by using our systems to inform the pharmacist about which patients are at risk — gives them more information about the patient at the pharmacy.
Part of what the data helps us understand … is how patients perform on adherence over time.
Also, e-prescribing has given us more insight into the problem of primary nonadherence, where the patient doesn’t pick up that prescription. If the prescription is coming right from the prescriber to the pharmacy, the pharmacy is at least aware that the patient should be getting this medicine, and can intervene.
DSN: In a case like that, what happens? Does the Walgreens central call center or a local pharmacist follow up?
Rudkin: It’s kind of a triage. The technicians make the initial call when a prescription has been in the pharmacy for about a week. The technicians can handle a lot of things, and sometimes it could just be that the patient says they’ve gotten samples from the doctor. But if the tech gets the impression that there’s something more going on, they will transfer the call to the pharmacist to intervene.
DSN: Has Walgreens considered adding dashboard technology or some other form of data access that pharmacists can pull up to give them a real-time read on individual patients’ adherence record? Or is that too much additional responsibility to put on the pharmacist?
Rudkin: That’s a good question, and I don’t think the industry has the answer to that yet. If we can use the systems corporately to tell the pharmacist that Patient A is nonadherent, is that useful information, and can it give the pharmacist a better look into where the patient is in their therapy journey? At this point, that’s been our primary focus. So we’re considering [dashboard technology], but we’re trying to leverage our technology to pinpoint those patients for our pharmacists, so they know who they have to intervene with. It’s not a decision they need to make or spend a lot of time thinking about. We try to do that for them.
DSN: Where is Walgreens in terms of moving ahead with a medication synchronization program?
Rudkin: We did a proof of concept in 2013, where we tested it on a very small scale. Now we’re looking to expand that to the pilot stage so we can understand where we can create efficiencies in the process, and make sure we can refine it so we can consider it on a larger scale.
Q&A: Engaging with patients at pharmacy
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.
Bayer’s Kogenate FS receives FDA approval
WHIPPANY, N.J. — Bayer HealthCare on Monday announced that the Food and Drug Administration approved the company’s new indication for Bayer’s Kogenate FS antihemophilic factor VIII (recombinant) for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults with hemophilia A.
The approval was based on data from the SPINART (Secondary Prophylaxis in Adults, a Randomized Trial) study: 84 patients ages 15 years to 50 years were randomized to receive either prophylaxis (25-IU/kg three times per week) or on-demand treatment. The results were published in the Journal of Thrombosis and Haemostasis.
"In Bayer’s SPINART study, adult patients with hemophilia A on the prophylactic regimen experienced significantly fewer bleeding events than those using on-demand treatment," said Marilyn Manco-Johnson, M.D., principal investigator of the study and director of the Mountain States Regional Hemophilia and Thrombosis Center at University of Colorado at Denver and Health Sciences Center. "Such clinical information can help healthcare professionals provide appropriate treatment advice to their patients."
Kogenate FS antihemophilic factor (recombinant) is a medicine used to replace clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A. Kogenate FS can reduce the risk of joint damage in children without pre-existing joint damage when used regularly, the company said. It also noted that the drug is not used to treat von Willebrand disease.