SMART RETAILING RX BLOG

Coaching at the pharmacy counter

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A SIMPLE method at pickup that improves medication adherence

In brief:

  • Patients not taking medications as prescribed had more than $100 billion in healthcare costs annually.
  • Pharmacists have the knowledge and patient contact to improve adherence using behavioral coaching techniques in their patient interactions.
  • Using behavioral techniques can structure conversations and support better patient adherence in less time than standard conversations.

Change your conversation

How many of you just ask, “Do you have any questions for the pharmacist?” This won’t lead to the types of revealing, meaningful conversations that can uncover and address barriers to patients taking their medications. Too often patients will answer with a simple, “No.”

One of the first steps to spark real conversations is to ask open-ended questions, which require more than a “Yes” or “No” response. As an example, a pharmacist might say, “Tell me how you are feeling with this medication” or “I’ve noticed you aren’t taking this prescription every day. Why is that?”

A SIMPLE framework

Here’s a SIMPLE mnemonic developed by health researchers to guide pickup conversations that boost adherence and patient satisfaction:

  • Simplify the regimen. About 40% of Americans age 65 or older take 5 or more drugs each week.1 Ask customers what types of difficulties they may have following their prescriptions. Interventions that might help range from asking physicians to adjust medications so they can be taken together to providing compliance packaging.
  • Impart knowledge with permission. Pharmacists typically see patients more frequently than prescribers, providing additional opportunities for patient education and reinforcing information that patients may have forgotten from their last visit with their physician. Always ask if you can share some information before imparting advice. Even a simple, “Is it OK with you if I share some information?” demonstrates respect for the patient and makes it much more likely that a patient will listen and act on your advice. Talk with patients in simple language, without medical jargon, and ask if they would like to hear more information.2,3
  • Modify patient beliefs and human behavior. The key to behavior change is to have the patient set their own short- and long-term, specific, measurable goals for changing their behaviors, such as taking medications on time, exercising and eating well. Telling them what to do isn’t effective, and can lead to the opposite behaviors in some people. Take the time to understand their personal goals, help them identify obstacles to achieving their goals, and engage each patient in thinking through their own solutions to their challenges.
  • Provide communication and trust. Listen and build rapport. Don’t just say, “I understand”; prove that you do by the comments and feedback you provide. For example, “It can be frustrating when a new medication causes a side effect.” Show that you empathize with their emotions and understand the causes. Reflecting back what the patient says or confirming that you heard them correctly demonstrates that you value your patients’ experience. Counsel patients in an area that provides privacy and comfort.
  • Leave the bias. Tailor your communication to each patient and adapt your messages to patients’ cultures and languages. (See Better Serve Patients with Low Health Literacy.)
  • Evaluate adherence. The only way to know whether coaching is making a difference is to continue checking with patients. Ask questions such as, “Can you describe any times when you have had difficulty taking your medications or decided not to take them?” or “I’d love to hear how your medication regimen is going? What is working for you and what isn’t working?”

Synchronizing all of a patient’s medications for delivery once per month is an important step toward improving medication adherence — but it is definitely not the only tool available to help pharmacists boost adherence.

A med sync program can reveal when patients aren’t taking medications as prescribed, because the patient’s refills won’t follow the expected schedule. That’s an opportunity for pharmacists to uncover issues and work with patients to improve adherence.

During medication therapy management (MTM) sessions , brief conversations when refilling prescriptions , or even formal health coaching sessions, pharmacists can provide knowledge, guidance, and interventions that lead to patients better complying with a medication regimen that is vital to the patient’s health.

The impact of nonadherence4

According to statistics compiled by Pharmacists Mutual Insurance Co. from its own data and other national sources:

  • Medication nonadherence contributes to 125,000 deaths annually.
  • Between 20% and 50% of patients are not taking their medications as prescribed.
  • The cost of medication nonadherence is estimated at $100 billion to $300 billion a year, including $2,000 per patient in physician visits and 10% of hospitalizations.

Coaches don’t create winning athletes in one session. Work with your customers to address one or two issues at a time and guide them in setting their own short-term, measurable goals to keep them on track.

Improved medication adherence does more than improve patient outcomes and increase the refills at your pharmacy. Making a measurable improvement in patient adherence will improve your pharmacy’s performance on Star Ratings measures and allow you to show providers that you have the skills to make a difference in patients they send to your pharmacy.

For more information

According to statistics compiled by Pharmacists Mutual Insurance Co. from its own data and other national sources:

 

1 “Aging and Drugs,” J. Mark Ruscin and Sunny A. Linnebur, Merck Manual Consumer Version. LINK
2 Wolever R. et al. (2010). “Integrative Health Coaching for Patients with Type II Diabetes: A Randomized Clinical Trial.” The Diabetes Educator. 36:629.
3 Rollnick, S., Miller, WR, Butler, C. (2008) “Motivational interviewing in healthcare: helping patients change behavior.”
4 “Medication Adherence Clinical Reference,” American College of Preventive Medicine. LINK.