Medication adherence: process for implementation

Figures & data

Figure 1 Simplified approach to improving medication adherence.

Table 2 Process to evolve clinical services in AF

Identify therapeutic challenge	Establish team and deliverables	Patient education and support	Integration of IT	Measurement
Underuse of standard anticoagulation with warfarin	Apply lessons learned from coordinated care model	Modify content for patient education based on new service model	Adjust inputs in EHR beyond warfarin clinic support	Continue to identify appropriate patients who benefit from anticoagulation therapy based on risk criteria
Emergence of newer anticoagulation	Translate focus of AF management to newer treatment options	Determine specific messages on range of options for anticoagulation therapy	Update EHR and smart sets to address current patient needs	Compare results from clinical trials to compare translation of potential benefit and harm
Limited access of anticoagulation services	Expand clinical services to include vascular disease prevention often associated with AF	Expand access to include anticoagulation services, medication management, and vascular prevention	Broaden focus to include electrophysiology and general cardiology within a given practice environment	Determine value of AF and vascular prevention clinic across services within a cardiology practice
Management of newer agents that may not require monitoring and monthly visits	Develop a schema for nonwarfarin anticoagulants and expand clinical services	Base patient visits on individual patient need and associated comorbidities	Set standards of care in AF patient population based on more comprehensive approach to care	Determine options to address improved overall outcomes as well as patient safety and satisfaction

Abbreviations: EHR, electronic health record; AF, atrial fibrillation.

Table 1 Connectedness of patient, provider, and health care system

Patient	Provider(s)	Health care system
• Patient needs information and dialogue with providers to clarify preferences and assimilate learning from the provider encounter into a relevant plan for self-care (shared decision-making).	• Provider or team must provide information to patient in a sensitive and meaningful way, such that the patient is enabled to make shared decisions and is involved in care plan.	• System must enable access for patient to secure services and support clinical team to optimize patient care through education, compassion, and continuity of care.

Figure 2 Adherence triad.

Abbreviation: HIT, health information technology.

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.