21 ways to boost medication adherence

The $290 billion problem of medication adherence is one of the top challenges to pharmacy practice. According to Jim O’Donnell, pharmacist and chief pharmacy executive at Community Health Network in Indianapolis, Ind., “Medication access and adherence are huge but mostly unknown national concerns. When 40% or more of patients with a chronic disease fail to take their medications as prescribed, the consequences are staggering. A reduction in the patient’s quality of life, unnecessary emergency room visits, and hospitalizations add more on to our national healthcare costs.  We must figure out a way to improve.”

A partnership

Seeking a way to get pharmacists in the Indianapolis area thinking deeply about medication adherence, O’Donnell approached Butler University College of Pharmacy and Health Sciences (COPHS). He met with Dr. Julie Koehler, associate dean for clinical education and external affiliations, and her team to discuss the idea of a live CE program.

“At Butler University, we loved the idea of working with Jim and Community Health Network to co-sponsor a live CE program for pharmacists across several practice settings in the Indianapolis area, to share ideas on improving medication adherence,” said Koehler. “However, we not only wanted to host a continuing professional development program for pharmacists that was educational; we also wanted it to be a little quirky and fun - to make it ‘edutaining.’”

21 flavors

The result of the collaboration was a half-day CE program for pharmacists titled “21 flavors: Ideas on how we might increase medication adherence.” The first CE program was held at Butler University on July 25, 2013.

Each of 21 speakers had five minutes to present an idea on how to encourage medication adherence. Speakers were gonged when their time was up, a strategic maneuver designed to keep the room energized and the exchange of ideas going.

To make each of the 21 ideas more memorable, each speaker had to choose a “flavor” for his or her talk. After each set of three talks, program participants were given five minutes to reflect upon the ideas presented and ask themselves whether each idea could be used in their own practice settings.

After all 20 speakers (one speaker presented two ideas) offered their suggestions for improvement of medication adherence, participants were asked try one of the 21 ideas in their own practice settings within three months of the live program. Follow-up assessments will gather information on the ideas each participant tried and on their results.

Outcomes

Presenters and participants enjoyed the novel presentation.

Butler faculty member Dr. Alison Walton commented, “Fun! Great idea! We should do more of this and expand … sharing and collaboration!” 

Dave Burand, a CVS pharmacist and Butler preceptor, said,  “It was fun, creative, and as thought-provoking a day as I have spent in a long while.”

O’Donnell concluded, “We’d love to see all pharmacists and other providers put on their thinking caps and address the challenge of medication adherence. It would be great to start developing momentum in addressing access and adherence concerns.”

Q&A

Here are the suggestions made by the 20 presenters.

1. How might we help engage children diagnosed with asthma and their parent in the asthma-management process?

Read a children’s book on asthma. – Dr. Erin Albert

2. How might we engage children in an asthma action plan?

Create an interactive game on tablets for children, integrating a game with an asthma action plan. – Dr. Sarah Saft

3. How might we engage patients in conversation withmotivational interviewing (MI)?


Use Care management Central (for training staff on MI) and Health Coach 4 Me (for patients).
 – Dr. Laura Buelt

4. How might we predict irrational behavior of patients in medication adherence?

Understand irrational behavior by reading the book Predictably Irrational. – Dr. Nick Sciacca

5. How might we teach pharmacy students empathy for patients regarding medication adherence?

Require a pillbox simulation assignment for students. – Dr. Alison Walton

6. How might we quickly assess patients’ health literacy before counseling?

Use the Rapid Estimate of Adult Literacy in Medicine –
 Short Form and USP’s Pictogram library. – Dr. Kate Klyczek

7. How might wehelp patients perform a complete medication reconciliation and keep an accurate medication list?

Write an Excel Spreadsheet, or use MedCoach app or My Med List for smartphones. – Dr. Tracy Costello

8. How might we
 put choice forward
 in healthcare to engage and empower patients?

Offer dosage-form options to patients for their medications. – Joe Holman

9. How might we unearth what truly motivates our patients to be healthy and take their medications?

Find true motivations for each patient, as they are different. – Dr. Julie Koehler

10. How might we improve communication between the pharmacist and the physician?

Pick up the phone and call when a patient doesn’t pick up his meds. – Dr. Stewart Brown

11. How might we help patients swallow their medications?

Instruct them to take several drinks prior to taking medications; to eat soft foods such as Jell-o or applesauce; and then to take the medications - and not to crush medications without asking
a pharmacist first. – Dr. Eric Farmer

12. How might we eliminate silos in healthcare?

Collaborate through partnerships like The Community Health Network and Walgreens Take Care Clinics, with shared EMRs. – Dr. Stacey Bailey

13. How might we 
make medications more affordable for patients?

A medication assistance program (MAP); and creating an accurate medication list, especially when patients shop at many pharmacies.
– Jennifer Koehler

14. How might we
 as pharmacists help our patients put their medications into pillboxes?

Use pharmacy pillboxes with color-coordinated lids on vials with boxes. In the future, use wireless pillbox-filling data delivered wirelessly. – Dr. Megan Dorrell

15. How might we use technology such as texting to improve medication adherence?

Help patients set reminders on their phones, or use technology like FrontlineSMS. – Dr. Lisa Fletcher

16. How might we 
get to know different patients with different disease-state challenges with medication adherence?

Use the 4/5As of smoking cessation with all patients. – Dr. Kathleen Haynes

17. How might we
 have automatic med
lists with practical, usable information for patients?

MyChart in EPIC is a start from the handwritten med list; MedActionPlan.com is also a tool. – Dr. Emily Papineau

18. How might we 
help patients manage their medications via smartphone app for free?

Try My Med Schedule mobile app (for patients, this
is a free application). – Dr. Joe Owen

19. How might we make medication packaging more patient-friendly and faster to use?

Switch from multiple-dose containers to single-dose containers from drug manufacturers. – Jim O’Donnell

20. How might we
 use wearable technology to improve our patients’ healthcare?

Recommend Jawbone UP wristbands, Pebble: E-Paper watch, Google Glass, and other wearables to patients. – Jim O’Donnell

21. How might we decrease hospital readmissions resulting from poor medication adherence?

Ensure that patients leave the hospital with the medications they need. – Dr. Alex Ansar

Erin Albert is assistant professor and director of continuing education at Butler University College of Pharmacy and Health Sciences. To watch the CE proceedings online, go to https://sites.google.com/a/butler.edu/21-flavors-butler/.