SAN DIEGO — Medication adherence, compliance and persistence are closely related terms, but all call for the involvement of an active patient to be successful.
David Nau, senior director of research and performance measurement at the Pharmacy Quality Alliance (PQA), and Rick Mohall, director of clinical services at Rite Aid Corp., outlined innovative approaches that pharmacies and health care groups have been taking to improve medication adherence and patient health outcomes in a session at the National Association of Chain Drug Stores Pharmacy and Technology Conference.
Pharmacies, as health and wellness destinations for the public, are key providers of compliance and adherence programs, noted Mohall, who has responsibility for medication therapy management (MTM) and other programs at Rite Aid.
"We continue to develop programs to increase compliance and adherence," Mohall said, citing Rite Aid’s wellness+ loyalty program (which provides members with health and wellness benefits) and services such as medication therapy management, automated courtesy prescription refills and reminder calls.
"This approach is a win-win-win for our patients, for pharmaceutical companies and for our bottom line," he explained. "Our loyalty card program incents customers to fill their prescriptions, our refill program also allows our pharmacists to monitor compliance, and our MTM program provides patients with complex therapies an opportunity to measure adherence and outcomes."
In one initiative, Rite Aid has forged a PQA partnership with Highmark Blue Shield, a large regional health plan based in western Pennsylvania, and CECity.com, a technology partner, to improve the quality of pharmacy services.
Under the alliance, Rite Aid’s pharmacists have been trained to understand the compliance and adherence measurements in the PQA program, and the pharmacists have been provided with tools leading to patient interventions to ensure they understand the importance of compliance and adherence. The initiative is slated to lead to pharmacist reimbursement for those services.
Originally involving 54 Rite Aid locations in western Pennsylvania, the project has since been expanded to 240 stores so that pharmacists can compare their efforts with those of their colleagues.
To increase adherence, Mohall said, pharmacists should ask patients such questions as whether they feel their medications are doing more harm than good, whether they understand how their medicines can improve their health and whether filling their prescriptions presents them with a financial burden.
According to Nau, lack of medication has been cited as "America’s other drug problem." It has contributed to progression of disease and complications that have led to lower quality of life and even death. A higher adherence rate, he added, most often results in reduced rates for hospitals and total medical spending.
Employers are increasingly analyzing prescription data to examine such factors as the impact on productivity and the effect that nonadherence has on their total health care expenditures, Nau added, pointing to figures from the New England Healthcare Institute showing that a typical midsize employer with $10 million in annual claims might waste over $1 million because of nonadherence.
Efforts that Nau said have been attempted to increase adherence include electronic prescribing and reducing health plan member costs for chronic care medications.
The Pharmacy Quality Alliance aims to identify appropriate quality metrics for medication use and medication therapy management services. The alliance represents pharmacy providers, health plans, employers, PBMs, academicians, outcomes researchers, senior advocacy groups, health IT vendors, state and national health care associations and members of the pharmaceutical industry.
