Article by BJCP
Adherence to medication regimens has long been a barrier to achieving the health outcomes we want for our patients and they want for themselves. Collectively, healthcare providers have thousands of years’ worth of experience showing that taking medications correctly saves lives and improves quality of life so much so that now HIV patients have normal life expectancies, children with asthma can run, jump, and play as if they’ve always been able to breathe. Patients intuitively know that for their medication to work, they must take it. So why then is it the case that medication adherence isn’t 100% in chronic medications that can save your life. And perhaps more importantly, what can pharmacists do about it.
A recent article in the British Journal of Clinical Pharmacology provides an excellent approach to managing COPD patients that can provide an excellent framework for how we as pharmacists in community settings can better manage our chronic care patients. A strategic care plan if you will.
Pharmacists are in an excellent position to provide disease state information to patients and reinforce their physician’s advice. Moreover, the patient will see or at least speak to their pharmacist monthly. We can leverage that to provide behavioral reinforcement for things like smoking cessation, lifestyle modifications and just generally check in on our patients.
Because we see our patients so frequently, pharmacists are often the first line of defense when a patient’s disease state starts trending poorly. We can ask basic questions like “How are you feeling today?” or “I noticed you’re a few days late picking up your medication, how have you been?” Simple, open ended questions can help identify issues and we can help refer those patients to the right level of care.
Pharmacists can provide medication adherence counseling monthly during medication synchronization calls, provide education on doses, side effects, how to mitigate certain side effects, and medication or device utilization techniques. The therapy management pharmacists provide can help reinforce how important the medication is to maintain or achieve a desired lifestyle.
Because adherence to medications is based on understanding a medication, belief that the therapy works, and behavior modifications, the monthly guidance a pharmacist can provide can easily mean the difference between ideal adherence and therapeutic discontinuation. Therefore, consistent review of the therapy and regular follow up with patients is vital to successful disease management.
In a medication monitoring program in the Netherlands, pharmacist involvement was associated with a significant decrease in COPD exacerbations (-0.82 exacerbations/year), decreased total healthcare costs (333 Euros per patient) without sacrificing quality of care, and a significant reduction in treatment discontinuation (31.7% vs 16.1%).  Another great example of why more and more members of the healthcare industry are relying on the pharmacist to impact patient health and bend the cost curve.
T van der Molen, JF M van Boven, et al. Optimizing identification and management of COPD patients – reviewing the role of the community pharmacist. Br J Clin Pharmacol (2017) 83 192-201