Baby, We've Come a Long Way.

As long as there have been societies and physicians to treat them, there have been specialists whose sole purpose was to prepare and administer medicinal treatments.  Pick any ancient civilization, and there will be evidence of organized and skillful application of pharmaceuticals.  The modern drugstore varied significantly from its ancient counterparts, in that the proprietors were often making medical decisions by diagnosing and treating patients without the consultation of physicians.

And the pendulum swings again...  Pharmacists in today's drugstores are tasked with the responsibility of evaluating the appropriateness and managing the dispensation of pharmaceuticals prescribed to patients under a doctor's care, assuring - most importantly - that the patient is safe from interactions or adverse reactions.  Although dispensing responsibilities remain the same, we're beginning to see more clinical, preventative, patient care focused services available in the most convenient setting - the store on the corner.

I think everyone will acknowledge that this is possible because pharmacists, every day, are becoming a much bigger part of total health care - of total patient care - than ever before.  It's exciting to realize that the pharmacist role today and going forward has an opportunity to affect real, valued change in patient outcomes and the health care industry in the U.S. as we know it.  The glass half-empty side?  We're still chained to the verification computer.  But we're working on that.

Alas, The Wellness Experience has arrived.  The pharmacist is in front of the pharmacy, available to answer questions, provide valuable counseling, Medication Therapy Management, adherence solutions, immunizations, and preventative health care screenings.  A "Health Guide" is on duty to help patients navigate the store and their health care options, and enroll patients in upcoming health and wellness programs in the new "Health Corner".  In our mind's eye, we see better patient outcomes, the prevention of hospitalizations, and savings for patients, employers, insurers and - as a whole - the health care industry.  We also see the pharmacist practicing at their most valuable level.

For more than several years, pharmacists have been proving they are capable of much more than safely dispensing.  Health care reform is imminent.  Today it's hard to imagine a picture that includes mandatory insurance, wellness benefits to employees and employers, tax credits and cost-sharing, Medicare bundle payments to better coordinate patient care, annual fees for drug manufacturers based on market share, and incentives to participate in health and lifestyle programs to reduce the risk of chronic disease.  But I'm sure society will learn the new ways and adapt.

Reform will push the pharmacy profession to adapt as well.  It is predicted that pharmacists will provide patient-centered and population-based care that optimizes medication therapy, where the patients health outcome is the product, not the medication.  Some foresee pharmacists having the authority and autonomy to manage medication therapy and be accountable for patients' therapeutic outcomes, while working cooperatively with practitioners of other disciplines to care for patients.

When the pendulum swings again, we'll see.  I've only met one person in my life who likes change - Kelly Demitt.  The rest of us will be anxious, then able to tolerate, then understand, and then adapt.  We've kicked up a whole lot of dust behind us, but there's a whole lot of trail left in front of us.  Hold steady the course.  We'll make it.

A National Problem with Local Solutions

Patient medication adherence is a problem of national importance to all involved: patients, their caregivers, health plans, employers, physicians, pharmacists and health systems.  Any complacency about adherence directly leads to the failure of medical treatment plans.  Research has shown that, on the whole, we can assume 50% of patients do not comply with treatment recommendations, allowing for devastating consequences:

• 11 to 23% of all hospital and nursing home admissions, resulting in 340 deaths per day;
• three times as many physician visits and $2000 per year per non-adherent patient in additional costs compared to patients who are adherent;
• 20% of all unintentional pregnancies in the United States at a cost of $2.6 billion annually;
• 33 to 69% of all medication-related hospital admissions in the U.S. at a cost of $100 billion annually;
• costs of $50 billion annually from the loss in productivity.

The annual estimated cost of people being non-adherent approaches $290 billion and leads to the death of 125,000 Americans per year.  Clearly, prescription drugs work only if they are taken, and taking a medication as prescribed is a behavioral choice.

Research has proven that pharmacists - the medication experts - must be a part of the solution.  As strategies to lessen non-adherence are developed, it is pharmacists who have shown the ability to educate, problem-solve, and provide support directly to and with patients.  Our new Helping our Patients Stay Well adherence program starts on January 12th, and we now have the tools needed to help our patients address the practical and behavioral reasons why they may not take their medications.

Educating and working to change the patients' behavior requires different strategies for different people.  Trust, hope, fear, knowledge, motivation, literacy, confidence, and competency are key concepts in the drive to medication adherence.

"The rates of non-adherence to prescription medication therapy have remained stagnant for the past three decades; although these topics have been discussed and debated, these problems have generally been overlooked as a serious public health issue and, as a result, have received little direct, systematic, or sustained intervention.  As a consequence, Americans have inadequate knowledge about the significance of medication adherence as a critical element of their improved health."         Enhancing Prescription Medication Adherence: A National Action Plan

Surely, good patient adherence is following the agreed recommendations from their health care providers.  Non-adherence is as dangerous and costly as many illnesses.  It has become an
international epidemic; in the words of The New York Times, it is the "world's other drug problem."

The issue of why people don't take their medication, even when they need it to prolong or save their lives, belies simple explanation or demographics.  Some of it is human nature, and inner rebellious voice that resists the doctor's orders.  Many patients mean to take their pills, but don't write down what the doctor said and end up not following the directions correctly.  Others forget, particularly when they have do it more than twice a day.  But research has shown two significant reasons for non-adherence.  1.  The patient feels the medication is not necessary; and 2.  a fear of side effects. 

Behavioral changes, such as adhering to a medication, typically occur when patients are sufficiently motivated to make that change.  Being motivated to change is a natural result of the patient understanding that the benefits of the change outweigh the risks.  Pharmacists are in a unique position to help patients by better understanding the factors influencing the patients choices, and identify ways to alter those influences to improve patient motivation.