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    PPACA moves medication adherence to center stage


    The role of pharmacists in medication adherence has taken center stage nationally since last year's passage of the Patient Protection and Affordable Care Act (PPACA), when medication adherence and medication therapy management (MTM) were recognized as areas that should receive funding. The passage of PPACA expands MTM to more Medicare Part D beneficiaries and creates grants for providing MTM.

    Mark Gregory
    "Healthcare reform targets wellness and prevention as solutions to escalating healthcare costs. There is no better opportunity than proactive management of medication adherence and compliance for those diagnosed with 1 or many chronic conditions," said Mark Gregory, vice president of pharmacy and government relations for Kerr Drug in Raleigh, N.C. Gregory spoke in February at the annual National Association of Chain Drug Stores (NACDS) Regional Chain Conference about the role pharmacists play in medication adherence.

    The time is right

    The time is right for pharmacists to be included as part of community healthcare teams on MTM pilot projects to treat chronic diseases, according to the NACDS and the American Pharmacists Association (APhA). "As pharmacy education, training, and practice continue to evolve to a primarily clinical 'patient-centered' focus, pharmacists are gaining recognition from other healthcare professionals and the public as 'medication therapy experts,'" stated the NACDS Foundation and APhA's resource, "Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0."

    At Kerr Drug, pharmacists and technicians are encouraging medication adherence by "actively recruiting" patients to have their prescriptions placed in the chain's automatic prescription refill system, according to Gregory.

    "Kerr pharmacists identify appropriate patients and chronic medications that fit well in an automatic refill program, and request the patient opt-in to the program. The program is effective for the right patient and not only provides a benefit for the patient, but streamlines efficiencies in the pharmacy with workflow, customer service, and pharmacy inventory management," Gregory said.

    While automatic refill programs were introduced by mail-order pharmacies, many chains, including Kerr and CVS Caremark, are using automatic refill systems with a reminder message. "Automatic refills will increase adherence as measured by prescription claims, but it is not clear whether patients are taking all the medication sent to them. Concerns about potential waste should be balanced by improvements in adherence," Gregory said.

    Studies track success

    Pharmacies' automatic refill systems and pharmacists' counseling of individual patients are just 2 of the ways that pharmacists are helping improve medication adherence globally. Already, several pilot projects and studies have demonstrated the value of pharmacists in medication adherence and MTM.

    As recently as February 2011, a study published in the Annals of Pharmacotherapy found that pharmacists' counseling of diabetic patients can improve medication adherence.

    Researchers at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, Calif., surveyed 1,295 diabetic patients, most with type 2 diabetes. Most patients said that the counseling techniques that are "very" to "extremely helpful" are those that educate them on "taking medications as part of a daily routine" and "utilizing pill boxes."

    In addition, the patients who correctly answered the questionnaire (n=268) listed the motivating factors that would help them properly take diabetic medications: "the knowledge that diabetes medications work effectively to lower blood glucose" (81.3%), understanding how they can manage the side effects of their medications (60.5%), and better understanding of the drugs' benefits (71.6%).

    Pharmacists become proactive

    Candis Morello
    "These are all areas where pharmacists can become proactive and help our patients overcome barriers. We are in the best health profession to be able to provide that," said Candis Morello, PharmD, lead author on the study and associate professor of clinical pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences.

    However, the diabetic patients that Morello and her team surveyed said that doctors were the best health professionals to talk to about their medications (64.2%), above pharmacists (38.8%). "We still need to educate the public about what pharmacists are able to do, particularly in light of the MTM services that we are able to provide people," Morello said.


    Christine Blank
    Contributing Editor Christine Blank is a freelance writer based in Florida.