By: Sherin Pathickal, PharmD Candidate c/o 2016, Rahul Patel, PharmD Candidate c/o 2017, and Sierra Swaby, PharmD Candidate c/o 2020
The pharmacy profession is changing within the healthcare system by making pharmaceutical care one of its main responsibilities. Pharmaceutical care does not adhere to the way that pharmacists have traditionally practiced, but instead requires the pharmacist to work with the patient and other healthcare providers to promote health. Furthermore, pharmaceutical care requires that pharmacists take responsibility for preventing and resolving drug related problems, and for optimizing drug therapy, while involving the patient throughout the whole process.1 For this reason, pharmaceutical care does not end when the patient leaves the pharmacy, but it involves assessment, monitoring, documenting care and progress, and follow-up care.
The responsibilities of a pharmacist vary among different areas of practice. Pharmacist responsibilities cover a broad range, including activities such as dispensing medications, monitoring patient health, educating patients, and advising physicians and other health professionals on drug related questions.2 Furthermore, pharmacists are responsible for the patient’s welfare. In order to provide the best care, a pharmacist should develop and build a relationship with each patient. In doing so, the patient will feel more confident and comfortable in providing their medical history to the pharmacist, allowing the pharmacist to gather the proper tools and information needed to develop a drug therapy plan.
To build a solid foundation for a relationship between the pharmacist and patient, effective communication must ensure that each patient is getting the best drug therapy possible. One of the major obstacles to communication in a pharmacy is time. With a community setting that has largely become a business, pharmacists should remember to make themselves available to the patients. Each patient deserves and should have time with the pharmacist before they leave the pharmacy, so that they understand why they are taking the medication and how it should be taken, which will increase medication adherence. Caretakers should also be informed on how to properly administer medications to individuals who are unable to do so themselves. Student pharmacists can play an important role in developing this relationship by taking time to counsel each patient with attentiveness and empathy.
A study published by Ohio State University observed how pharmacists and patients engaged in communication about personal health within an independent pharmacy setting. Carmin Jane Gade, a graduate of Ohio State University with a Doctorate in Philosophy, commented on the pharmacist-patient relationship by explaining that, “communication often holds the missing link to success and should not be overlooked. Pharmacy care is likely to be directly correlated to individual’s health outcomes and well-being.”3 As current and future pharmacists, we should understand the influence of the care that we provide through a communicative relationship with the patient.
As pharmacists, one of the most pertinent counseling points that we can offer to all patients is the importance of medication adherence. The Annals of Internal Medicine published a study that looked at patient compliance and its impact on the healthcare economy. Of the medications that were filled, nearly half were taken inappropriately.4 The consequences of not taking medications as prescribed are costly and can be dangerous, often leading to poor disease management, hospitalizations, and even deaths.4 Emergency room visits and hospital stays increased as well, by 17% and 10% each year respectively.5 This was mainly due to an inability to afford medication, a common problem that leads to a lapse in medication compliance. These numbers only underline how noncompliance can lead to increased costs on the healthcare system.5 Even more shocking is that nearly a quarter million people in the USA die each year due to lack of medication adherence.6 These costs can all be avoided if the proper counseling and patient education take place, a responsibility that mainly lies with the pharmacist.4 The New England Healthcare Institute (NEHI) predicts that approximately 290 billion dollars could be saved each year with proper adherence and medication education.7
Patient adherence is an aspect of pharmacy that has been a recurrent problem. The question remains: How can we fix it? Can we, as pharmacists, actually make a difference and improve a patient’s compliance in taking his or her medications?
In a retrospective study conducted during the fall of 2010, patients who had hyperlipidemia were prescribed simvastatin and were placed into two groups, one of which received counseling from community pharmacists, and the other which simply took their medications and went home. Each patient was asked if they were available for consultation with the pharmacist, and those who refused did so due to time constraints, due to a caregiver or someone other than the patient picking up the medication, etc. Those who were part of the intervention group received two sessions, one at the initial pickup, and one following a refill pick up where they were asked about their adherence. Over 500 subjects were in each study group and compliance was monitored through the medication possession ratio (MPR), in which the total days’ supply of medications during the treatment period were divided by the number of days in the treatment. Anyone who had a value over 80% was considered to be adherent to the therapy.8
Results indicated that those who received counseling on the benefits of being adherent to their medications were more likely to be compliant (40.9% for the group who received counseling vs. 33.7% for those who did not, and the data was found to be statistically significant with a p<0.05).8 Although both groups had a downward trend in the MPR and adherence over time, the rate of decline was consistently lower for the intervention group. After 12 months of follow-up, the rate of adherence measured via MPR was 56.9% vs 61.8% in favor of the intervention group, with a p< 0.01. Persistence in terms of whether or not the patients filled their prescription within the allotted period of time was also higher for the intervention group with 43.9% filling on time as compared to the 38.2% in the comparative group (p=0.05).8
Although further studies need to be conducted using larger populations and various disease states, this study gives credence to the fact that pharmacists play an influential role in patient adherence and treatment management. With further education and guidance from the pharmacist, more patients may become adherent to their medications, leading to a decrease in economic costs and complications due to non-adherence.
Despite the fact that pharmacists have been a large part of our healthcare system for many years, their role is constantly being redefined. We are known as the drug experts, and as such, we are a source of valuable information as well of help for those who are concerned and have questions about their health. As pharmacists, it is important that we take an active role in counseling each patient. It not only leads to a clearer understanding about questions and concerns each patient may have, but also plays an important role in underlining the necessity of medication adherence. As interns and future pharmacists, it is vital that we understand, and appreciate, the role that we can play in managing a patient’s health.
- Berger B. Communication Skills for Pharmacists. Washington, D.C.: American Pharmacists Association; 2009. Print.
- Role of a Pharmacist. American Association of Colleges of Pharmacy. http://www.aacp.org/resources/student/pharmacyforyou/Pages/roleofapharmacist.aspx. 2015.
- Gade, CJ. An exploration of the pharmacist-patient communicative relationship. Ohio State University. Available at: https://etd.ohiolink.edu/ap/10?0::NO:10:P10_ACCESSION_NUM:osu1061259087. Published 18 April 2015.
- Fung B. The $289 billion cost of medication noncompliance, and what to do about it. The Atlantic. Available at: http://www.theatlantic.com/health/archive/2012/09/the-289-billion-cost-of-medication-noncompliance-and-what-to-do-about-it/262222/. Published 11 Sept. 2012.
- Goldman DP, Joyce GF, Escarce JJ, et al. Pharmacy Benefits and the Use of Drugs by the Chronically Ill. JAMA. 2004;291(19):2344-2350. doi:10.1001/jama.291.19.2344.
- Medication adherence: a $300 billion dollar problem. Prescriptions for a Healthy America. Available at: http://adhereforhealth.org/who-we-are/medication-adherence/#_edn4. Updated 2015.
- Thinking outside the pillbox. New England Healthcare Institute. Available at: http://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf. Published August 2009.
- Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Prefer Adherence. 2;6:323-9. doi: 10.2147/PPA.S29353.