About 3.8 billion prescriptions are written each year; however, an estimated one in five are never filled, according to a 2017 Morbidity and Mortality Weekly Report from the CDC. In addition, approximately 50% of prescriptions are taken incorrectly based on timing, dosage, or frequency of duration recommendations.
This nonadherence has costly implications. Each year, costs associated with nonadherence are estimated to be between $100 and $300 billion in the United States, according to the CDC.
Research shows that pharmacist counseling can improve patient adherence, but despite these studies, overall adherence rates have continued to remain low over several decades.
"We haven't changed the way we talk to patients," says Bruce Berger, PhD, president of Berger Consulting, a company that provides education and training on motivational interviewing techniques. "We're stuck in an old paternalistic model of care, where we tell people what to do and assume if we educate them that's enough."
To enhance patient counseling skills, experts believe pharmacists need to move beyond reciting medical knowledge to a more collaborative and conversational approach—even when the time for each patient interaction is short.
Here are some specific strategies pharmacists can use to perfect their counseling skills.
Obstacles to Effective Patient Counseling
Patient counseling can be hindered by several factors, but the biggest obstacle for most pharmacists is time.
Jen Alexander, PharmD, pharmacy manager at NuCara Pharmacy in Pleasant Hill, IO, also noted that time is the biggest obstacle to effective counseling. In her current role at a regional chain she's given sufficient time to interact with each patient, but says she's had jobs in the past where that wasn't the case.
"The other thing is patients who aren't receptive, and that's discouraging," she says, adding that even in these cases she tries to highlight the most important information for a patient for a given medication. In the hospital setting, patients may not be receptive to counseling efforts because they may be overwhelmed by a new diagnosis or simply aren't in a frame of mind where they can process the information, says Jacqueline L. Olin, PharmD, BCPS, FASHP, a professor of pharmacy at Wingate University School of Pharmacy, Charlotte, NC.
Other potential obstacles include a patient's health literacy, cultural, or language barriers, a perceived lack of privacy in a community pharmacy setting, or an incomplete picture of a patient's health state or habits.