A3

Healthcare Professionals

Prescribers

“My practice predominantly serves those over age 65, and I know how challenging it is for some of my patients to keep track of multiple medications. Sometimes, patients get confused about how and when to take their medicines, and even stop taking them once they start feeling better. I often have to deal with drug side effects, too – increasing the risk of cascading – when a patient comes to me not feeling well due to a drug’s side effects, and I end up treating that with another drug. The best way to handle these challenges is to regularly communicate with my patients. Our nurse practitioner tracks some patients who have multiple chronic conditions and talks with them regularly about their treatment challenges and goals. And the result – we’re helping keep patients healthier and out of the hospital. That’s a win/win for all of us!”

A3 Recommendations Advocate For…What You Can Do…
Establishing medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.
  • Get involved if you’re not doing so already! Talk with your state or local allied health professional society or association about how it can support efforts to address medicine adherence in the context of treating chronic conditions.
Establishing the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.
  • Consider the strategy of integrating a patient navigator into your practice (staff member who can obtain patient medical records, create accurate medication lists, set up medication counseling as needed, schedule timely follow-up visits and facilitate communication between patients and their different physicians).
Promoting clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions.
Incentivizing the entire healthcare to incorporate adherence education and medication support as part of their routine care for MCC patients.
Eliminating the barriers that impede the ability of patients with multiple chronic conditions to refill their prescriptions.
  • Support the synchronization of medication refills. This is of particular concern for patients who are seeing multiple prescribers.
Reducing the cost-sharing barriers for patients by lowering or eliminating patient copayments for prescription medicines used to treat the most common chronic diseases.
  • Support adoption of policies that will reduce out-of-pocket costs for medications, especially for patients on multiple prescriptions for chronic conditions.
Accelerating the adoption of new health information technologies that promote medication adherence.
  • Adopt new guidelines for the use of electronic health records standards that provide for consistent data collection, ease of use and provider access to the comprehensive electronic medication information for a given patient.
  • Support the creation of provider incentives to use health information technology that helps identify patients at risk for poor medication adherence.
  • Promote patient/provider and provider/provider sharing of electronic health records while ensuring patient privacy.
  • Expand the use of electronic reminders, e-prescribing and personal health records to improve medication adherence and optimal use by consumers. Specifically consider promoting the use of the AMA’s My Medications app, available for Apple iPhone®, iPad® and iPod Touch® on the AMA iTunes store.
Establishing medication adherence as a measure for the accreditation of healthcare professional educational programs.
  • Support the integration of medicine adherence into the graduate medical education program as part of the adoption of the Accreditation Council for Graduate Medical Education’s (ACGME) “next accreditation system,” in 2014.
  • Support integrating behavioral counseling and communications skill-building with patients as core competencies within the curriculum of schools of pharmacy, nursing and other allied health professions – including cultural competencies, identifying patients at high risk for nonadherence, motivational interviewing and how to work in a multidisciplinary environment with clarity of roles.
Addressing multiple chronic conditions and optimal medication management approaches in treatment guidelines.
  • Encourage medical societies to accelerate the development or adoption of evidence-based treatment guidelines where information on the most common chronic comorbidities is included. Give priority to the most prevalent dyads and triads identified by the Centers for Medicare and Medicaid Services (CMS) where patients are likely to be taking a variety of different drugs and may be receiving conflicting advice from prescribers and other healthcare providers.
For rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.
  • Support research efforts to:
    • Expand information on the most prevalent clusters of multiple chronic conditions and the medicines used to treat these diseases.
    • Identify the care models that are most successful in improving the health outcomes of patients with MCC.
    • Define the most appropriate health outcomes for these individuals in light of the cumulative effect of having a constellation of different diseases.
  • Consider getting involved in clinical trials that address how to effectively treat MCC.
Pharmacists

“I understand and appreciate my role as a patient educator and medication adherence advocate. I’m ideally-positioned because I’m communicating with doctors and  their patients and can effectively interpret medication instructions and answer questions if patients get confused. As Baby Boomers get older, I see my role expanding, and I’m excited about the possibilities!”

A3 Recommendations Advocate For…What You Can Do…
Establishing medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.
  • Get involved with your state and local pharmacy associations and ensure that the treatment of chronic conditions is being addressed – including the role that MTM can play in treating these conditions – and how such practices can promote safe and appropriate medicine use.
Establishing the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.
  • Help promote and advocate the important role you play in improving medicine adherence by integrating the use of innovative, pharmacist-involved programs that can help patients at all levels achieve better medicine adherence and improved health outcomes.
  • Promote strategies to support the role of patient adherence navigator. Here’s an innovative example, the CVS/Caremark Pharmacy Advisory Program which focuses on improving diabetes outcomes. Using pharmacy claims data to identify gaps in care or medication issues, the program utilizes local pharmacists in the company’s retail stores to contact the patients and follow up with either face-to-face counseling or a phone consult, based on the person’s preference.
  • Also see the Patient-Centered Medical Home Model that relies on a team of providers to provide comprehensive and continuous patient medical care.
Eliminating the barriers that impede the ability of patients with multiple chronic conditions to refill their prescriptions.
  • Support the implementation of the “pharmacy home” concept which gives patients a single pharmacy point of contact for filling prescriptions so they don’t have to visit multiple pharmacies to fill different prescriptions.1
  • Provide useful, easy-to-read patient medicine information (PMI) to patients, and supply this information in a variety of formats and languages.
  • Provide easy-to-read flyers that include point-of-contact information so patients have a name and phone number to call if they have questions.
  • Establish a medication synchronization program which allows patients to refill multiple medicine prescriptions in a coordinated fashion, thus reducing pharmacy visits to obtain medications.
Accelerating the adoption of new health information technologies that promote medication adherence.
  • Integrate strategies that will improve medicine adherence. Examples include:
Establishing medication adherence as a measure for the accreditation of healthcare professional educational programs.
  • Help support efforts to designate medication adherence as a core competency within the pharmacy curriculum, and include skills-based competency in adherence as a measure for accrediting schools of pharmacy and nursing.
Stimulating rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.








1. The Medication Adherence Roadmap: A Path Forward, NEHI. http://www.nehi.net/publications/58/roadmap_to_improved_patient_medication_adherence.


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