Patient Compliance Treating Chronic Diseases 2012 NAFC Annual Summit October 22, 2012
Mission: Rx Partnership is a public/private partnership which exists to increase access to medication for Virginia s vulnerable populations and serve as a resource to the organizations that support these populations. Rx Partnership serves as a broker, facilitating the distribution of free prescription medication from six participating pharmaceutical companies to 23 Affiliate free clinics and community health centers with licensed pharmacies, who then dispense to individual patients
Video Rx Partnership & the Chronic Care Collaborative http://www.youtube.com/watch?v=ofqrgwy-gbs The U.S. population is aging and more than one half of Americans live with at least one chronic condition
The Issue: Medication Adherence Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments Nonadherence to prescription medication is an important public health problem with serious implications: Patients will be sicker Access the healthcare system more often Have higher overall healthcare costs then adherent patients
Medication Non-Adherence FACTS Cost of poor adherence estimated at $290 billion in 2009 by New England Healthcare Institute ($177 billion ten years ago) Of that nearly $300 billion, more than $100 billion is concentrated in four cardio-metabolic disorders: diabetes, hypertension, high cholesterol and heart disease. Regardless of gender, medical condition, ethnicity or age, thirty to fifty percent of all patients are non-adherent. 1 out of 3 patients who take medication requiring refills will discontinue their medication before getting their first refill 3 out of 4 people stop taking their medication within the first year of starting therapy
Medication Non-Adherence FACTS 1 out of 8 heart attack patients stops taking life saving drugs after just 1 month 31% of all prescriptions are not filled the first time 15% of all hospital visits ($47 billion/annually) are due to medication non-adherence 125,000 deaths annually are the result of non-adherence
Improving Adherence Pharmacists as the medication experts play a key role in improving medication adherence. Healthcare providers are campaigning to raise public awareness about: Taking medication properly The importance of filling their prescriptions The need for medication in treating prevalent chronic diseases (diabetes, respiratory and heart disease) Improving communication with patients about their medications
Challenges & Answers Patient Challenges Understanding their disease state Importance of medication Cultural and emotional challenges Pharmacist Answers Training and desire to help Know patient and focus on educating Live the culture, face to face interaction
Health Literacy Definition "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." http://nnlm.gov/out reach/consumer/htlhlit.html
Health Literacy Reasons Skills Affected Lack of Education Evaluating Learning Disabilities Analyzing Cognitive Decline Calculating Lack of Use Interpreting http://nnlm.gov/out reach/consumer/htlhlit.html
Dispensing Tools Pill Boxes Designated flip-top compartments (daily, weekly, AM, PM) Sort pills by days on Sunday of each week Blister Pack Dispense prepackaged medications organized by day Only for patients without small children
Medication Record Personalized medication list Includes drug, dose, indication, instructions, prescriber Manual tracking systems to designate when taken (+, x, *) Medication calendar Pharmacies can provide calendars with refills Include space for medications and tracking
Technological Tools Alarms Watch Phone Clock-radio 1 out of every 2 patients does not take, refill, or check vital statistics as instructed by their physician. Mobile phone applications Free iphone app Pill Tracker Prescription Reminder Text www.rxmind.me 84% cite forgetfulness as the main reason.
Refill Tracking Keep track of patient refills Give reminders when medication has not been filled as scheduled Provide incentive for medication adherence Reward points Coupons Gift cards
Education Important for healthcare providers to ensure optimal drug therapy Stress importance of taking medication as prescribed Ensure patients understands how to take medication Link medication to condition being treated how it can help A key factor in non-adherence is that patients may frequently have an incorrect understanding or an unrealistic expectation from their doctor of what their medications will do for them. Act as a multidisciplinary team to improve medication adherence
Role of Pharm Techs Pharmacy technicians are invaluable in identifying: Overuse Underuse Drug interactions/adverse drug events Health literacy issues Income issues Clinics may utilize other administrative staff members to help identify issues
Survey Information Rx Partnership Conducted a Survey in early 2012 Concern about patients compliance / medication adherence rated as a 5 by 31 out of 38 respondents (scale of 1-5) About half of organizations have a strategy to address this issue Education activities by the organization focus primarily on the patient followed by physician, nurse and then pharmacist Approximately 80% of respondents track refill frequency Survey Respondents 50 Individuals 28 Organizations represented
Ideas & Techniques Some strategies to explore: Presentations Handouts Medication leaflets Posters Meetings w/ Patients Individual Group Patient-to-Patient Interactions Regular Medication Reviews Weekly Pill Boxes Tracking of Refills BYB Bring Your Bottles Events Emmi video Medication Education Epocrates PDR
RxP Pharmacy Posters
Cost-Related Nonadherence CE Publication Developed to provide information on identifying potential warning signs for nonadherence and share resources to assist patients in need of medication Partnership with Virginia Pharmacists Association for CE Credit High marks from those completing the CE, which is available through June 30, 2013
Specific Adherence Campaigns Simplify My Meds National Community Pharmacists Association (NCPA) allows pharmacists to coordinate all refills to a single day of the month www.stick2thescript.org NCPA Resource tools, programs and other resources to help patients understand goals and outcomes of their prescription regimen, manage chronic conditions and take medication as directed. www.scriptyourfuture.org National Consumers League has a variety of tools, resources & ability to set-up text reminders to take medication www.talkaboutrx.org National Council on Patient Information and Education October marks NCPIE s 27th national Talk About Prescriptions Month. Voices Together theme signifies the impact that many voices - rather than one - can have on promoting safe and appropriate medicine use through better medicine communication.
Contact Information To learn more about Rx Partnership or request a copy of the additional CE on Cost-Related Nonadherence contact: Amy Yarcich, Executive Director 2924 Emerywood Pkwy, #300 Richmond, VA 23294 804-377-1057 x1557 AYarcich@RxPartnership.org www.rxpartnership.org