Medication adherence: process for implementation

Abstract

Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications.

Keywords:

• medication adherence
• pharmacy
• policy
• health care systems
• self-management
• patient education

Supplementary materials

Review of adherence-related websites

Adult Meducation: Improving Medication Adherence in Older Adults

Available at: http://www.adultmeducation.com/

The American Society on Aging (ASA) and the American Society of Consultant Pharmacists (ASCP) Foundation have collaborated on the development of Adult Meducation: Improving Medication Adherence in Older Adults, a web-based program (Figure S1) to educate ASA and ASCP members on important aspects of medication adherence in older adults. One goal of the program is to encourage ASA members to work together with ASCP member pharmacists to identify, resolve, and prevent medication nonadherence in the older adults served by community-based service providers. This website contains:

• Information on factors that influence medication adherence, barriers to adherence, and specific strategies to improve adherence

• Tools to identify older adults at risk for medication nonadherence

• Resources to improve medication adherence

• Materials to educate older adults about the importance of medication adherence

• Educational programs targeted at community-based service providers and health professionals

• Links to other useful web resources

• Materials on the website that can be copied or downloaded for use in educational or training programs

Agency for Healthcare Quality and Research – Innovations Exchange

Available at: http://innovations.ahrq.gov/index.aspx

In addition to user tools and project descriptions on a wide range of clinical issues, the website (Figure S2) provides specific tools and research summaries in the area of medication adherence, which can be utilized by clinicians and researchers alike.

American College of Preventive Medicine

Available at: http://www.acpm.org/

The American College of Preventive Medicine provides a website (Figure S3) directed at providers to educate about the complex challenges of medication adherence with an additional summary of resources and tools, which may be incorporated into the practice environment.

Script Your Future

Available at: http://www.scriptyourfuture.org/

The Script Your Future campaign is a national public education campaign developed to raise awareness among patients, their family caregivers and health care professionals, about the importance of taking medications as directed. The campaign, led by the National Consumers League, focuses on patients affected by three serious chronic conditions – diabetes, respiratory disease, and cardiovascular disease. Script Your Future educates patients about the consequences of poor adherence, encourages patients and health care professionals to better communicate about medication, and offers tools and resources to help improve adherence. The interactive Script Your Future website (Figure S4), offers tools for both patients and health care professionals, including fact sheets on chronic conditions, charts to keep track of medications, videos, sample questions, text message alerts, and more.

Launched in May 2011, this unique three-year national campaign has targeted outreach efforts in: Baltimore, MD, USA; Birmingham, AL, USA; Cincinnati, OH, USA; Providence, RI, USA; Raleigh, NC, USA; and Sacramento, CA, USA. In addition to the website, the integrated campaign includes public service announcements, material dissemination, social media presence, health professions, and student out-reach activities. Script Your Future is supported by a coalition of more than 130 public and private partners.

National Council on Patient Information and Education

Available at: http://www.talkaboutrx.org/

Founded in 1982, the National Council on Patient Information and Education (NCPIE), located in Rockville, MD, USA, is a nonprofit multistakeholder coalition working to stimulate and improve the communication of information on the appropriate use of medicines to consumers and health care professionals. NCPIE, since its beginning, has strongly advocated for the medicine education team – considering the patient the key player. NCPIE develops and provides valuable patient education programs and educational resources promoting the latest advances in communication research and practice. NCPIE’s public-facing websites (Figure S5) include: talkaboutrx.org; bemedicinesmart.org; bemedwise. org; mustforseniors.org; and recoveryopensdoors.org

NCPIE works to address critical medicine safe use issues like adherence improvement, prescription drug abuse prevention, treatment and recovery, medication error reduction, quality improvements in health care provider–patient medicine communication, and safe storage and disposal of medicines.

With mounting evidence that poor medicine adherence will increase dramatically with the projected rise in age-related chronic illnesses, NCPIE released a nationwide call to action – the Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda (October 2013) – that places a spotlight on the pervasive and costly problem of poor medicine adherence, particularly among those age 65 and older with multiple chronic conditions, who are at the greatest risk of medication errors, drug interactions, and costly disease complications.

North Carolina Program on Health Literacy

Available at: http://www.nchealthliteracy.org/

Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The concept of health literacy differs from literacy itself. Health literacy requires basic reading skills, but it also requires the ability to understand oral communication, use numbers and math skills, understand how to navigate the health system on a basic level as well as the ability to communicate with health care providers and their staff. To that end, the University of North Carolina School of Public Health has provided an extensive list of tools and resources to help clinicians better understand and implement good practices of health literacy (Figure S6).

Pharmacy Quality Alliance

Available at: http://www.pqaalliance.org

Established in 2006, the Pharmacy Quality Alliance is a 501(c)(3) designated nonprofit alliance with more than 100 member organizations (Figure S7). The Pharmacy Quality Alliance is a multistakeholder, consensus-based membership organization that collaboratively promotes appropriate medication use and develops strategies for measuring and reporting performance information related to medications. Their mission statement is clear:

To improve the quality of medication management and use across healthcare settings with the goal of improving patients’ health through a collaborative process to develop and implement performance measures and recognize examples of exceptional pharmacy quality.

National Patient Safety Foundation (NPSF)

Available at: http://www.npsf.org/about-us/

The NPSF’s vision is to create a world where patients and those who care for them are free from harm. A central voice for patient safety since 1997, NPSF partners with patients and families, the health care community, and key stakeholders to advance patient safety and health care workforce safety and disseminate strategies to prevent harm. NPSF is an independent, not-for-profit 501(c)(3) organization. Among their resources is a unique clinician–patient interface tool called Ask Me 3 (Figure S8), which allows a quick effective engagement with patients regarding medication adherence.

Figure S1 Adult Meducation: Improving Medication Adherence in Older Adults.

Figure S2 Agency for Healthcare Quality and Research – Innovations Exchange.

Figure S3 American College of Preventive Medicine.

Figure S4 Script Your Future.

Figure S5 National Council on Patient Information and Education.

Figure S6 North Carolina Program on Health Literacy.

Figure S7 Pharmacy Quality Alliance.

Figure S8 National Patient Safety Foundation.

Disclosure

The authors have no conflicts of interest to declare in respect of this work.