Case Managers Improve Communication Among Patients, Providers, PharmacistsNearly 133 million Americans—more than 40 percent of the total population—are affected by chronic and generally incurable diseases. This number is projected to grow to an estimated 157 million, including 81 million with multiple conditions, by 2020.
Not surprisingly, more than 75 percent of all healthcare costs are related to chronic health conditions, such as diabetes, heart disease, hypertension or mental illness. The treatment of these and other chronic illnesses commonly includes long-term medications.
Yet the full benefits of many medications may not be realized because an estimated 50 percent of patients do not take them as prescribed. A key role of care managers is engaging patients to consistently take their prescribed medications.
Challenges to Medication Adherence
There are several factors contributing to poor medication adherence, including elements related to the patient, physician, pharmacist, and other healthcare providers. Because these barriers are complex and varied, solutions must also be multifactorial.
In a study written by the former Surgeon General, data revealed between 33 percent and 69 percent of readmissions to the hospital are related to poor medication adherence. Failing to take medication according to directions or to refilling prescriptions on time increases the likelihood and presents a major challenge to the healthcare system.
Unfortunately, in the last decade, poor medication adherence has grown and now an estimated $300 billion is spent annually as a result of incurring extra costs related to medical complications in hospital readmissions.
In some cases, physicians do not have sufficient information about their patients’ consistency in taking medication. This might be related to the increasing number of issues that must be addressed during a short office visit and that physicians tend to expect their patients will take medication as directed. Thus, they rarely ask detailed questions about missed doses or adherence.
Patients also interact with pharmacists while filling their medications or calling with questions, giving the pharmacist special insight into what’s happening with each patient’s medication. For instance, pharmacists may have information that a patient doesn’t believe the medication is needed, that the medication isn’t available, or that it may trigger side effects. Unfortunately, communication occurring between the pharmacist and physician is usually sporadic and only reactive to problems once they occur.
Managing communication between pharmacist and physician is a golden opportunity for case managers to support collaboration and the achievement of treatment goals. Other medication-adherence barriers the case manager can address are social and economic factors; patients’ motivations; level of physical or cognitive impairment; and challenges related to specific therapy or the medical condition being treated. Barriers also include drug costs, dosing schedules and the family’s level of understanding and acceptance of the particular chronic disease.
Patient Engagement with Healthcare Providers Reaps Significant Rewards
Still, the assistance of care managers doesn’t negate the need for pharmacists and physicians to take the time to engage with their patients. Studies show that kind of engagement reaps significant rewards resulting in improved patient outcomes and lower healthcare costs. In one study, researchers found when patients were involved in decision-making and self-care activity through the support of their healthcare provider, they exhibited better medication adherence, and reporter fewer symptoms related to their disease.
Better healthcare management results in lower healthcare costs to the individual, insurance companies, healthcare system and the community. One method physicians have been using to engage their patients outside the office is customizable technology, allowing physicians to send refill alerts to their patients or remind them when it’s time for a checkup.
Engagement with their healthcare provider means patients are more likely to stick with their treatment plan and maintain their medication schedule. However, while many technology companies are focused on physician office communication with patients, these interactions can also be successfully accomplished by the case manager who has an intimate knowledge of the medical and medication history of their client.
Collaboration with a physician office or pharmacist increases the potential for medication adherence and thus a reduction in overall financial, physical and mental cost. People over 60 consume 50 percent of prescribed medications and by 2030, 20 percent of the population will be 65 years or older. With an aging population, chronic disease becomes more prevalent, increasing the opportunities for case managers to successfully impact healthcare interventions.
Community Pharmacies Provide Services Aimed at Medication Adherence
In a study by the National Community Pharmacists Association, data revealed the use of appointment-based medication synchronization made patients 2.57 times more likely to be adherent to their medication schedules. Unlike other auto-refill programs, the system builds on an established relationship between the pharmacist and patient to provide high touch interactions.
The system leverages multiple technologies as part of a network to complete tasks ranging from scheduling appointments, sending reminders and reviewing orders. Pharmacist then meet with patients face-to-face to go over potential issues or those in need of additional services. The authors of the study claim the system simplifies the pharmacies workflow, giving the pharmacist more time for patient interactions and a personal connection.
Lack of medication adherence may be related to polypharmacy, or taking multiple medications concurrently to treat one or more conditions. Many patients find managing multiple medications difficult, often leading to missed doses or medications that are not refilled.
One pharmacy in New Haven, Conn., offers a prepackaged, individualized blister pack or pill box containing a one month supply of medication. If patients can’t remember if they took their medication, the blister pack confirms they did or didn’t. Rather than guessing how many pills remain at the bottom of the bottle, the blister pack encourages timely refills and decreases the chances of delays.
Other community pharmacies are exploring medication synchronization as an option to improve adherence. This strategy coordinates refills so they all fall on the same day every month, implementing systems to identify patients who have uncoordinated refill dates and calculating short-term or partial refills that are out of sync.
The pharmacy is the last verification step before medications go home and many are instituting services to resolve polypharmacy complications and identify patients who have significant trouble with adherence. This is yet another touch point for case managers who are seeking to reduce overall healthcare costs and improve patient outcomes by collaborating with healthcare professionals in the community and within the institution.
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