ISSUE: As we reorganize our health system to meet the Triple Aim , how do we maximize the pharmacist’s contributions to appropriate, safe, and cost-effective medication use (including medication adherence)?
RECOMMENDATION: The contributions of medication management, including adherence, to the Triple Aim of a reorganized healthcare system can be amplified through the integration of comprehensive pharmacist services at the individual patient and population levels.
CURRENT LAW: Currently, federal law does not explicitly address medication adherence. Federal law addressing health professions education is found at 42 USC 293 et seq. Federal law addressing payment to providers for the delivery of services to Medicare beneficiaries, in particular the definition of those providers and services, is found at 42 USC 1395 et seq.
BACKGROUND: Over the past decade, attention to the problem of medication adherence has escalated in the United States and globally. The World Health Organization published a report in 2003 on medication adherence, noting that approximately 50% of patients with chronic illnesses in developed countries do not take that their medications as prescribed . In the United States, up to 2/3 of medication related hospital admissions  are a result of medication non-adherence costing the US health care system 100 to 289 billion dollars annually . Consequently in response, a ground swell of action across healthcare policy, payment and patient organizations has resulted, including steps taken by the Institute of Medicine, AHRQ, the Partnership for Patients, the pharmaceutical industry, the Centers for Medicare and Medicaid Services and multi-organization collaborations such as the Pharmacy Quality Alliance and Script Your Future [4,5,6,7,8,9].
Adherence to medications is an important part of improving health outcomes . Positive health outcomes depend on accurate diagnostic ability, selection of appropriate medical treatment, patient adherence and persistence with the established treatment plan and sufficient follow-up and monitoring. Pharmacy education prepares pharmacists whose competencies include the ability to improve patient outcomes through the provision of a broad range of medication management services .
The American Association of Colleges of Pharmacy recognizes that strategies to achieve desired outcomes associated with medication management services, including medication adherence, require a pharmacist who is culturally competent; is able to communicate effectively with patients, their care givers and providers; and provides person-centered and team-based, collaborative care .
Ultimately, the ability to improve medication use outcomes requires a comprehensive approach to medication management of which medication adherence is one strategy . Effective medication management is a shared responsibility between the patient and their providers. Providers need to ascertain the reasons for non-adherent behaviors and help patients overcome any personal challenges with medication adherence.
Pharmacists may prove to be the most accessible and knowledgeable health professional to help patients with poor medication adherence. Assessing and managing medication adherence is a major role for pharmacists [14,15]. Evidence supports the efficacy of pharmacists providing these services [16,17]. Yet, tackling non-adherence and its complexities requires a team approach. Pharmacists will need to work closely with patients, their families or caregivers, and health care providers. Tools to facilitate this coordination of care include medication refill notices that can be reported back to providers with EMRs, encrypted secure e-mail systems, and codes that allow a pharmacist to transmit a patient medication adherence assessment to an emergency room physician . Effective management of patient and population medication outcomes will require a broad set of strategies of which medication adherence is just a start.
For additional information contact:
William Lang, MPHVice President, Policy and AdvocacyAmerican Association of Colleges of Pharmacywlang@aacp.org703-739-2330 x1038
 The IHI Triple Aim. In this document AACP paraphrases the IHI triple aim. The IHI triple aim refers to “the simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.”  Sabete E. ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland. World Health Organization: 2003. Osterberg L, Blaschke T. Adherence to Medications. N Engl J Med. 2005;353:487-97. Viswanathan M, Golin CE, Jones CD, et.al. Interventions to Improve Adherence to Self-Administered Medications for Chronic Disease in the United States: A systematic Review. Ann Int Med. 2012;157:785-95. Ashok M, Blalock S, Wines RCM, Coker-Schwimmer EJL, Grodensky CA, Rosen DL, Yuen A, Sista P, Lohr KN. Medication Adherence Interventions: Comparative Effectiveness. Closing the Quality Gap: Revisiting theState of the Science. Evidence Report No. 208. (Prepared by RTI International–University ofNorth Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQPublication No. 12-E010-EF. Rockville, MD: Agency for Healthcare Research and Quality.September 2012.  US Department of Health and Human Services. Partnership for Patients, Patient and Family Engagement. Merck Engage Your Patients. Accessed 2/23/2013 Pfizer Prescription for Health. Accessed 2/23/2013 Center for Medicare and Medicaid Services. Medicare Health and Drug Plan Health Care Quality and Performance Ratings, Part C and Part D 2013 Technical Notes. Accessed 2/23/2013. ASHP Statement on the Pharmacist’s Role in Medication Reconciliation. Am J Health-Syst Pharm. 2012;70:453-6.  Barnett MJ, Frank J, Wehring H, Newland B, VonMuenster S, Kumbera P, Halterman T, Perry PJ. Analysis of Pharmacist-Provided Medication Therapy Management (MTM) Services in Community Pharmacies Over 7 Years. J Manag Care Pharm. 2009;15(1):18-31. Cumulative Policies of the American Association of Colleges of Pharmacy  ASHP Statement on the Role of the Medication Safety Leader. Am J Health-Syst Pharm. 2013;70:448-52. Medication therapy Management in Pharmacy Practice. Core Elements of an MTM Service Model. Version 2.0. American Pharmacists Association and National Association of Chain Drug Stores Foundation. March 2008.  PCPCC. The Patient Centered Medical Home: Integrating Comprehensive Medication Management to Optimize patient Outcomes.  Lee JK, Grace KA, Taylor AJ. Effect of Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure and Low Density Lipoprotein Cholesterol: A randomized control trial. JAMA 2006;296:2563-2571. Kuo GM, Touchette DR, Marinac JS. Drug Errors and Related Interventions Reported by the United States Clinical Pharmacists: The American College of Clinical Pharmacy Practice-Based Research Network Medication Error Detection, Amelioration and Prevention Study. Pharmacotherapy 2013;33(3):253-65. Pharmacy e-Health Information Technology Collaborative. Accessed 2/23/2013.