In addition to dispensing, medication review forms another significant part of a community pharmacist’s routine as studies strongly supported that repeated monitoring and counselling had tremendous positive impact on patient's adherence towards their medication.
Pharmacists are specially educated to identify and solve medication adherence issues. When these professionals are further trained in behavioural change communication that is tailored to individual needs and circumstances, they represent a formidable combination to help the patient in coping to even to the most complex medication regimen.
Clinical benefits of the patient support programme
Patient support programmes, when led by well-trained pharmacists, can improve adherence among patients. This is evident in the programme jointly run by Celesio, an integrated healthcare services provider, and MSD, a pharmaceutical giant. The programme showed improvements in medication adherence of up to 61% among diabetic patients.
Most astonishingly, the greatest improvements came from patients whom beliefs were fixated at the adverse effects of the medicine and scored worst at adherence.
Laura Southall, Celesio’s service design manager for medicines adherence and patient support, said, “We wanted to provide targeted support that was tailored to the individual needs of patients and we therefore segmented them according to their risk of non-adherence (High, Medium and Low) as well as their type of non-adherence (intentional versus unintentional).”
Studies indicated that patient’s concern belief where medicine causes more harm than good is the primary reason why certain individuals intentionally deviate from the prescribed medication regimen. The complex treatment regimen was shown to associate with non-adherence as well, and perhaps rightly so as patients grew frustrated over time.
This accumulated evidence strongly supports the notion that pharmacists should be allowed more time with patients to explore the reason behind non-adherence, dispel and clarify any misconception about medication and improve their understanding of how a particular medicine works.
It is interesting to note that pharmacists who worked in the Celesio/MSD patient support programme were specially trained in behavioural change technique. Poor health behaviours typically occur through a complex socio-ecological environment that a successful intervention programme must be carried out at multiple levels and by qualified personnel.
Strategic positions of community pharmacies
Community pharmacies are typically well-suited to spearhead any initiative to improve patient adherence, as many of these pharmacies are located at the heart of the local community. There are over 1,800 community pharmacies in Malaysia and distributed across different regions.
Most, if not all, community pharmacists foster good interpersonal relationships with their customers. Many of them are on the first-name basis with each other. Additionally, many community pharmacists are already helping their patients to review medications and provide counselling when it is necessary.
However, these medication review exercises are conducted voluntarily and do not represent the bread and butter of a community pharmacy. Additionally, most pharmacists are not specifically trained in behavioural change therapy and related techniques.
Although there is a huge role for them in supporting their patients, there may not be an attractive funding option for them to spend more time with their patients. The lack of a centralised shared electronic medical record between GPs and community pharmacies is another major hurdle towards replicating the success of the Celesio/MSD programme.
Thinking outside the box
Faced with the ever increasing demand for community pharmacists to provide more value towards their patients, some of the more resourceful ones turned towards the retail coffee and snacks store industry for inspiration.
“We want to sit down and talk with patients about their drugs” was the motivation behind the one-of-a-kind pharmacy café on Edmonton. The Twin Brooke Pharmacy and Awake Coffee House aim to make the pharmacy business more patient-friendly and to allow more personal interaction between the pharmacist and their patients.
Patients are given the freedom to sip coffee while waiting for their prescriptions to be filled. The community-oriented atmosphere within the pharmacy also encourages them to ask questions and build relationships with the staffs. Thus far, business is booming and the pharmacists are looking forward to serving more people with good coffee and filled prescriptions.
Improving patient adherence to medication treatment is, without question, a challenging task. Nonetheless, with a little creativity and innovation, community pharmacists will find themselves in a strategic position to boost adherence and close the loop on a successful medication therapy. MIMS
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