Adherence programs first must identify patients that are not adherent and/or are at greater risk for health complications if they are not adherent or compliant. Adherence programs are considered targeted MTM services. It is important that medications are assessed for appropriateness, safety, and effectiveness before an adherence intervention begins.
NOTE: Automatic refills and refill reminders are a tool used in an adherence program but are not in and of themselves an adherence ‘program’
Programs must first identify patients as being non-adherent or noncompliant and may include items such as:
- Patients who never pick up the first fill of a new maintenance medication for a chronic health condition.
- Patients who never pick up an antibiotic prescription (or other acute care prescription)
- Patients who do not finish the complete course of an antibiotic prescription
- Patients who get a new maintenance medication prescription and do not return for a refill.
- DUR data indicates that the refills are being filled and picked up early or late (indicating taking too much medication or skipping doses)
Then the barriers to compliance or adherence must be identified and may include items such as:
- Cost of the medication – patients cutting medication in half or skipping doses because they cannot afford the medication
- Multiple times per day dosing that can be confusing, especially for patients on multiple medications and can result in under or over dosing
- Literacy issues – patients that do not understand the directions
- Health literacy issues – patients that do not understand the importance of adherence and the consequences of non-adherence
- Perceived or actual side effects or the patient’s fears about medication effects
The pharmacist works with the patient and prescriber to solve the issues, devise a plan, and monitor patient for adherence. Documentation to include: patient communication, health provider communication, plan of action including goals, and follow-up plan.