Adherence

Why is it so hard for patients to be adherent to their treatment plan?
Health care is fragmented, siloed, and complicated. Each patient has specific needs and there is little communication and coordination of patient care. A patient’s health care team, including their pharmacists, physicians, and health plan, rarely communicate about a specific patient. Each member of the health care team has different pieces of information pertinent to patient health. Communicating this information in a clear manner within the health care team and with the patient is an integral component of successful treatment plan implementation. Patients don’t adhere to their treatment plan because they are provided fragmented information about that plan; it’s confusing, it’s complicated, and there is little follow up.

Heart disease, for example, is the leading cause of death for all Americans age 35 and older, costing the nation over $286.5 billion each year.1 One person dies every 30 seconds from heart disease.1 With that type of an impact, it is intuitive to think that patients would follow their treatment plan which typically includes using medication. Why then do 30% of patients not get their first prescription refill for medications used to treat heart disease?

There is little care coordination causing a patient’s treatment plan to be fragmented, confusing, and complicated. Patients typically spend less than 7 minutes with their doctor who makes a diagnosis. The patient may not understand the diagnosis, may not understand the importance of medication therapy, or may be in denial that there is anything wrong. Because heart disease is asymptomatic, patients don’t feel bad or sick; they are confused that medication therapy is needed when they feel fine. The doctors don’t have time to fully communicate with patients.

Patients may head to the pharmacy where they wait in line to get their medication and interact with a technician, or patients send their prescription to a mail order pharmacy and don’t interact with anyone. Pharmacists are uniquely trained to counsel patient on medication and lifestyle modification, but they are not available to most patients. Face to face pharmacist interactions are logistically impossible within our current pharmacy structure. Most pharmacies today do not have private patient counseling areas, pharmacists are responsible to fill 200-300 prescriptions per day with little allocated time for patient counseling. Most pharmacies do not have proper software systems to adequately provide personalized patient counseling. Even if pharmacists did provide counseling to patients in the pharmacy, they only have access to a fragment of the patients total treatment plan.

Interactions with patients about their treatment plan must be convenient and available when patients have questions, concerns, or issues. Interventions must be provided by a health care professional trained specifically to hear a patient’s needs and concerns. All discussions with patients must be personalized to that patient, and be based on the patients full treatment plan; ideally, including their physician based treatment plan, their medication plan, and their health insurance coverage. Outside of a patient’s physician, only a pharmacist working independent of filling prescriptions can provide this service to patients; helping patients achieve their treatment plan adherence goals.