Rebecca W. Chater, RPh, MPH, FAPhA

Medication nonadherence is a major cause of morbidity, especially in elderly patients. Approximately 10% of hospitalizations may be a result of medication nonadherence.

It is not only an individual patient’s health problem, but also contributes up to $300 billion of avoidable healthcare costs in the United States (US) and up to 30% of wasteful spending.

By 2030, 20% of the US population will be aged 65 years or older.

Patients over 60 years of age consume 50% of dispensed prescription drugs.

As the population continues to age, chronic disease becomes more prevalent. This translates to an increase in the volume and complexity of medication regimens, increasing the risk for nonadherence. Other factors increasing the likelihood of nonadherence in the elderly include adverse drug reactions that come with polypharmacy, decreased visibility and motor dexterity, and decreased autonomy.

A study assessing the link between potentially inappropriate medicines and avoidable adverse drug events in patients 65 years or older found 68.9% of hospital admissions were avoidable or potentially avoidable due to inappropriate medications.

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Patient nonadherence to prescribed medications is associated with poor therapeutic outcomes, progression of disease, increased healthcare utilization, and an estimated burden of billions per year in avoidable direct healthcare costs. 

Patient Engagement Solutions for Medication Nonadherence in Older Adults

Recently, Amazon announced its entry into pharmacy through the acquisition of PillPack, a service that delivers medications, presorted in adherence packaging, to a patient’s home. The announcement has the profession, and the industry debating several questions around the deal’s impact on local pharmacies, and the role of the pharmacist in this process. At last estimate, the burden of nonadherence on our healthcare system exceeded $300 billion in direct and indirect costs, with approximately 50% of patients not taking their medications as prescribed, indicating a clear opportunity to mitigate related barriers to improved adherence.

While convenient access to medications certainly aids adherence, and could be facilitated by the PillPack acquisition, the deal stands to disrupt direct pharmacist-to-patient contact, and the essential role of the community-based pharmacist within the healthcare continuum. Convenience of medication delivery is not a panacea for resolution of nonadherence, and falls woefully short in addressing other critical aspects of addressing medication-related problems including unanticipated medication interactions, gaps in care, cost challenges, lack of patient education, lifestyle incompatibilities, and others.

Rather than focusing on the PillPack acquisition by Amazon as a threat, pharmacists have an opportunity to reassess the value that they bring—the existing patient care services, tools, and technology that equip them to deliver patient-centric, personalized care. Whether employing data analytics to more efficiently identify needed interventions, adherence packaging, or medication therapy management, pharmacies can enhance their service offerings to differentiate their practices and keep patients at the center of care.

Pharmacists have long differentiated themselves with patients by stepping up to help with the confusion around managing multiple medications, and monitoring health issues. By using technology to streamline patient communications and offering adherence tools, such as multimed blister cards, that can be customized to each patient, pharmacists can ensure they're not edged out by the online retailer.

This is especially true when patients experience care transitions. From one care setting to the next, they need the pharmacist as a local resource to help ensure smooth transition and guide them on their path to better health outcomes. Research has shown that pharmacists are specially qualified to fulfill this role, helping to address concerns, and reduce medication errors that might not always be evident. One-size-fits-all approach that Amazon is developing circumvents the role of the local pharmacist and is not designed to meet the individualized needs of patients with unique health concerns.

Enhancing Pharmacy Care for Better Results

As our nation’s most accessible healthcare professionals, pharmacists serve as touchstones of care in communities all across the country, offering patient-centered, personalized, and coordinated care. Emerging data-driven solutions provide pharmacists with tools they need to increase their value through targeted clinical engagement, enabling them to further improve health outcomes, reduce healthcare costs, while offering a level of patient convenience that rivals Amazon-PillPack.

Centralized, actionable data specific to managing patient engagement is essential to improving care while reducing costs across the care continuum. For this reason, healthcare needs a system that not only provides convenience related to medication access—as this Amazon acquisition aims to do&mdash;but also keeps the pharmacist regularly connected to the patient to evaluate medication-related health needs on an ongoing basis, communicating as needed with patient and prescriber regarding medication adherence, potential medication changes or dosage adjustments, side effects, drug interactions, needed vaccinations, and more.

The coming months will reveal changes that result from the Amazon-PillPack deal. In the meantime, pharmacists should take this as an opportunity to amplify their value to further differentiate their practices, ensuring that their role will not be diminished by this new venture. By staying connected to their patients and implementing tools that help to expand their service offerings and improve patient care, today’s pharmacists will reinforce their own essential role in the care continuum, now and in the future.

Healthcare needs a system that not only provides convenience related to medication accessâ€”as this Amazon acquisition aims to doâ€”but also keeps the pharmacist regularly connected to the patient.

Rebecca W. Chater, RPh, MPH, FAPhA

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Patient Engagement Solutions for Medication Nonadherence in Older Adults

An Evolving Pharmaceutical Market Presents Challenges, Opportunities to Pharmacists