Patient adherence

& compliance: A positive role for pharmacy techs

By Jim Frederick

Every day, pharmacy technicians face patients with a multitude of health challenges and chronic onditions, ranging from minor pain-management issues and common colds to life-threatening illnesses. But one of the biggest health challenges confronting pharmacy staff isn’t linked to any one disease and often goes undetected for weeks or months: the challenge of patients’ noncompliance or nonadherence with doctor-prescribed medication therapy.

It’s no secret that millions of patients fail to keep up with — or sometimes even to initiate — their own prescription drug regimen. The problem has become so acute that many health experts now consider it a full-blown American healthcare crisis.

“Nonadherence has been likened to a chronic illness and referred to as an epidemic, with no regard for gender, race, economics or education,” noted a recent report from drug maker Boehringer Ingelheim Pharmaceuticals.

It’s important to recognize the similari-ties — and differences — between the terms compliance, adherence and persistence. The 2009 Medication Adherence Report from BI defines the terms this way:

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• Compliance is “the act of taking medication on schedule, or taking medication as prescribed.”

• Adherence is “the act of filling new prescriptions, or refilling prescriptions on time.”

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• Persistence is “the act of taking medication for the duration prescribed.”

 

There’s no mistaking the staggering toll to Americans’ health and the nation’s healthcare pocketbook taken by noncompliance. One study, published in the New England Journal of Medicine, found that one-third to one-half of all patients in the United States do not take their medications as prescribed.

According to numerous studies, noncompliance, nonadherence and nonpersistence with medication therapy cause an estimated 125,000 needless deaths a year, along with untold health problems and recovery setbacks to millions more.

Recent research from the New England Healthcare Institute suggested that costs resulting from nonadherence may be as high as $300 billion annually.

A broad coalition of healthcare and consumer organizations, including the National Association of Chain Drug Stores and the National Consumers League, is lobbying to improve compliance messaging between health workers and patients. Sally Greenberg, the League’s executive director, noted in October that “patients don’t take their medications for a variety of reasons, including cost [issues] such as co-pays and deductibles, side effects, misconceptions or fears, and trouble with administration.”

It follows, then, that pharmacy technicians can play a key front-line service in the battle to improve patient drug-therapy

compliance and outcomes. As the coalition noted recently, “Strategies to improve medication adherence must fully engage patients, and patient-centered care must involve strategies to help them better understand their conditions and treatments.”

The need for such interventions is particularly acute among older patients. As one researcher noted, “Patient compliance with drug therapy deteriorates as the number of drugs taken by the patient increases. Because 25% of the elderly use three or more drugs daily, the elderly are particularly at risk.”

Pharmacy techs can make a real and sometimes critical difference by their brief interactions with patients at the counter. Among the most effective steps, according to the BI report, are enhancing and encouraging the patient to talk, in particular by “practicing discretion and heightened sensitivity to help patients feel more at ease talking about their health or medication.” Pharmacy staff also can effectively promote compliance and persistence by “continually reinforcing the importance of a patient’s staying on their medication, even after they feel better.”

Among the strategies pharmacists could use to deal with those concerns, noted BI, are asking open-ended, probing questions; educating patients about flavorings, or the availability of liquid or chewable medicines; or practicing “active listening to show you understand the patient’s concerns.”