During COVID-19, keep chronic patients on track


Focus on adherence, education and immunizations

In brief:

  • With all the attention on COVID-19, make sure to focus on patients with chronic diseases
  • Multiple factors may keep these patients from taking their meds as prescribed
  • Pharmacist intervention can improve adherence and other health measures

Since February, COVID-19 has dominated the headlines, which will likely continue. While you may have had some patients affected by COVID-19, you definitely have many patients affected by chronic diseases. It is essential to maintain focus on these patients.

Already, 60% of U.S. adults have a chronic disease1, which means that many of your customers have at least one, if not multiple, chronic diseases.

Source: CDC2


Think about your patients with:

o  Heart disease

o  Cancer

o  Diabetes

o  Asthma


o  Stroke

o  Chronic obstructive pulmonary disease (COPD)

o  High blood pressure

o  Alzheimer’s disease

o  Kidney disease

o  High cholesterol

Patients with chronic illnesses have many challenges and present enormous opportunities for pharmacists to provide a wide range of important clinical services.

Understand non-adherence issues

About half of chronically ill patients aren’t adhering to their medication regimens, which leads to increased healthcare costs and preventable deaths (possibly 100,000 per year).3

As a pharmacist, you need to know if patients are not adherent, and why. There can be many reasons for non-adherence. By asking whether a patient is taking a prescription or having any issues, you may receive a quick “yes” or “no” — and these answers may not be accurate.

To really understand the situation, you need to ask questions in ways that encourage real answers.

Probing questions to understand adherence:

  • How are you taking your medication? This checks adherence and methods.
  • Why are you taking this medication? Patients who don’t understand are less likely to fill and refill their prescriptions. They may think they can stop if they don’t notice symptoms.
  • What issues are you experiencing with this medication? Unless you probe, a patient may not tell you about side effects that you can intervene to lessen or eliminate.

For many patients, cost is a factor in not filling prescriptions, as is lack of insurance coverage. About half of Americans say they have failed to fill a prescription when insurance didn’t cover it.4 Be willing to work with patients and providers to identify:

  • Covered drugs
  • Manufacturers’ discounts
  • Generic alternatives
  • If patients need help navigating appeals or denials

Also, be aware that when the economy takes a downturn, more patients may skip refills. It is important to be vigilant about monitoring and working with them. The COVID-19 pandemic has also raised awareness about the need to ensure that patients have an adequate supply of medication during disasters and to work with insurers to ensure access to fills.5 (See Key Components of Effective Adherence Programs.)

Engage in counseling and education

Fewer than half of patients with chronic illnesses are confident they can effectively manage their condition.6 Only 43% are confident they know their key numbers, such as weight and blood pressure.

Yet consultation and education by community pharmacists has been proven to improve medication adherence and:

  • Lower hemoglobin A1C in patients with diabetes
  • Reduce blood pressure
  • Cut hospital readmission rates in patients with heart disease
  • Improve lung function in patients with conditions such as asthma7

Your pharmacy can help patients with chronic conditions through services such as:

  • Comprehensive medication reviews (CMRs), which can be used to check the prescriptions patients take as well as supplements and OTC products. (See How to Conduct Comprehensive Medication Reviews.)
  • Cholesterol and blood glucose testing, which can provide patients more frequent information than just when they visit providers.
  • Patient education, which can range from checking if patients are using inhalers properly to offering diabetes self-management programs; insurers may cover some education programs.
  • Immunizations, which are recommended for many adults with chronic illnesses. The CDC provides an assessment form and an online Adult Vaccine Assessment Tool.
  • Addressing additional risk factors with screenings and programs to help patients with common issues such as smoking, poor nutrition, lack of exercise and depression.

Some pharmacies are finding ways to keep patients motivated through “gamifying” by awarding points for taking medications on schedule and tracking data such as blood pressure and weight, earning rewards such as gift cards.10


While assisting patients during the COVID-19 crisis, make sure to maintain focus on your patients with chronic diseases. During this challenging time, these patients need your assistance. Identify patients that aren’t adherent, understand why they aren’t adherent and help address their issues. Also, constantly engage in education and counseling, which has been proven to work.

Providing a wide range of services to patients with chronic diseases is very much the future of independent pharmacy. It is an opportunity to keep patients healthier while also earning revenue for your pharmacy.


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1 About Chronic Disease,” Centers for Disease Control and Prevention.
2 About Chronic Disease,” Centers for Disease Control and Prevention.
3 The Benefits of Integrating Adherence and Engagement into Copay and Hub Programs,” Haymarket Studio, MM&M, April 6, 2020.
4 When Insurance Won’t Cover Drugs, Americans Make ‘Tough Choices’ About Their Health,” Patti Neighmond, NPR Morning Edition, Jan. 27, 2020.
5 Planning for Prescription Drugs During the Coronavirus Outbreak,” Rachel Nania, AARP, March 10, 2020.
6 Strengthening Chronic Care,” West.
7 Impact of Community Pharmacist-Led Interventions in Chronic Disease Management on Clinical, Utilization, and Economic Outcomes: An Umbrella Review,” Terri V. Newman et al., Research in Social and Administrative Pharmacy, Jan. 14, 2020.
8 Treating Food as Medicine,” Optum.
9 Immunizing the 19- to 64-Year-Old Population With Chronic Disease,” Lincoln Alexander, Pharmacy Times, June 30, 2019.
10 The Benefits of Integrating Adherence and Engagement into Copay and Hub Programs,” Haymarket Studio, MM&M, April 6, 2020.