Improving Adherence, Building Relationships

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Everyone in healthcare knows that lack of medication adherence is a huge problem.

  • 20% of prescriptions are not filled1; 23% are not refilled; and 54% are not taken as prescribed.2
  • Poor adherence in the U.S. costs $290 billion per year.3
  • Lack of adherence causes 10% of all hospitalizations (30% for those over age 65)4, an estimated 10 million hospitalizations and 20 million ER visits each year.5
  • Improved medication compliance decreases hospitalizations (shown below) and reduces healthcare costs.6

Multiple factors affect adherence, including an individual’s environment, their attitudes and beliefs, the costs of their medications, and their relationships with caregivers.

The good news: There are proven techniques to improve medication adherence, and pharmacists can be part of the solution. And more good news: Being part of the solution improves patients’ health, decreases healthcare costs — and is good business for community pharmacies.

Why Community Pharmacists?

More than a third of patients (34%) said they would adhere better if they were provided easier-to-understand instructions about how to take their prescription medicines.7

This is where pharmacists come in. Community pharmacists are credible, trusted resources. They have personal relationships with patients, understand each individual’s unique situation, and usually see patients more frequently than physicians. Community pharmacists can be a resource for education, motivation, coaching, support and reminders. They can comfortably communicate with individuals in the context of their daily lives.

Programs to Support Pharmacists

Recognizing the important role that community pharmacies can play, McKesson has developed a suite of sponsored clinical services. One such service is McKesson’s Pharmacy Intervention Program, which involves manufacturer-sponsored coaching sessions. Key elements are:

  • Pharmacist training on motivational interviews. Pharmacists undergo web-based training on how to conduct patient coaching sessions at the pharmacy counter. Motivational Interviewing is a tool that enables community pharmacists to lead efficient, effective conversations with patients to positively impact medication adherence.
    This technique involves asking open-ended questions, expressing empathy, uncovering reasons for non-adherence, listening, identifying strategies for adherence success, providing information, and helping motivate and change behaviors.
  • Receipt of fax. Participating pharmacies receive fax alerts from McKesson when a good candidate is identified for a sponsored coaching session. A set of business rules set up through RelayHealth identifies eligible patients and triggers the fax alert; these rules also filter out ineligible patients.
  • Conduct coaching session. After receiving the fax, community pharmacists conduct the coaching session with the eligible patient. These interviews typically take 5 to 7 minutes. When the coaching session is completed, the pharmacist faxes the completed fax alert back to McKesson for reimbursement.

Benefits to Community Pharmacies

Improving adherence benefits patients by keeping them healthier. It saves healthcare costs by reducing unnecessary ER visits and hospitalizations. Playing a role in the adherence solution is also good business for community pharmacies. Here’s why:

  • Deeper relationships. Engaging in conversations about medications and motivations provides an opportunity to develop even closer relationships with customers.
  • Expanded services. Offering coaching sessions is yet another way for community pharmacies to broaden the services they offer. This continues to position the community pharmacy as a trusted, community-based clinical resource.
  • Increased revenue. Sponsored coaching sessions provide a new revenue stream for community pharmacies. These sessions can also help increase refill rates and traffic, which boosts revenue.

A Natural Fit

Kevin Winston, owner of Sutcliffe Pharmacy in Chicago — a fourth-generation independently owned pharmacy founded in 1888 — sees coaching sessions through the Pharmacy Intervention Program as fitting perfectly with his community pharmacy. For years, he and his staff have educated patients to help them be compliant. But the Pharmacy Intervention Program, which they have participated in for about three years, is a more structured way to address adherence.

While the increased revenue is nice, this isn’t his primary motivation. Winston is constantly seeking to reinvent his pharmacy by offering innovative new services that strengthen customer relationships and increase traffic. Coaching sessions are particularly valuable for people with chronic diseases. It shows patients that Sutcliffe Pharmacy cares about their well-being and creates customer intimacy. This builds personal relationships, which is what differentiates community pharmacies.

Kevin suggests that in this competitive environment, community pharmacies can benefit by taking advantage of adherence programs. They benefit patients’ health and a community pharmacy’s business.



1. Michael A. Fischer et al, “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions,” Journal of General Internal Medicine (Feb. 2010),25:4 284-290. DOI: 10.1007/s11606-010-1253-9.
2. Prescription Solutions, and the National Council on Patient Information and Education (NCPIE), “New Survey: More Than Half of Americans Do Not Take Prescription Medicines as Instructed, Pointing to Growing Public Health Problem,” Nov. 12, 2009.
3. New England Healthcare Institute, “Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease”, August 12, 2009.
4. E. Vermeire et al, “Patient adherence to treatment: three decades of research. A comprehensive review,Journal of Clinical Pharmacy and Therapeutics (2001) 26, 331-342.
6. M. Christopher Roebuck et al, “Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending,” Health Affairs (Jan 2011) 30:1 91-99.
7.  Prescription Solutions, and the National Council on Patient Information and Education (NCPIE), “New Survey: More Than Half of Americans Do Not Take Prescription Medicines as Instructed, Pointing to Growing Public Health Problem,” Nov. 12, 2009.