Patient Compliance and Medication Adherence During Covid-19

Jonathan Jacobs
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How to Maintain your patients Compliance during the Covid-19 Pandemic

So you’ve done everything to get the patients to come in the door and when they’re NOT in your pharmacy. They are certainly telling their own doctors and their support staff to forward all their new prescriptions to your store! This is great, but how do you keep them compliant? Where is the adherence? Why is there no adherence?   If you are a savvy independent pharmacy owner you realize that your maintenance meds are your stores’ main resource of continuous reliable prescription volume.  Reliable prescription volumes are your building blocks to a successful pharmacy!!!  How do you keep your customers compliant? How you do so may very well be the key to maintaining adherence!!

An unfortunate consequence of the COVID-19 pandemic is the avoidance of care for both acute and chronic purposes not related to the virus. There are multiple factors driving this, including the closing of small primary care practices, reimbursement for telemedicine lagging behind in-person reimbursement, fewer than 20% of visits occurring in person, and the number of primary care physicians dropping from 138,017 to 100,024 since March 2020.

COVID-19 Pandemic and Adherence to Therapy: What Can Pharmacists Do?


Medication adherence has long been recognized as an important, if under addressed, barrier to patient health. It can affect both quality and length of life, and overall health care costs. Nonadherence to medications has been correlated to up to 50% of treatment failures, approximately 125,000 deaths, and nearly 25% of hospitalizations per year in the United States. This impact has been valued at approximately $100 billion annually.

Proportion of Days Covered (PDC) is the preferred method to measure adherence to chronic medication therapies, according to the Pharmacy Quality Alliance.  The PDC threshold above which the medication has a reasonable likelihood of achieving the most clinical benefit is 80%. Despite this threshold, the adherence rates for many chronic disease medications are estimated at 50%-60%.  It is likely that in the coronavirus disease 2019 (COVID-19) era and its aftermath, we may see worsening adherence to therapy due to known factors that affect adherence and others that are unique to what is happening currently. This worsening adherence and compliance promotes the term “creep” which I’ll later explain a bit more.

Pharmacists are positioned to mitigate many of these factors.

You have many avenues to maintain adherence/compliance with your patients from your packaging OR Multi-Dose Packaging solutions such as co-mingle meds and/or blister packs that encourage how your meds are presented to you for taking at specific times of day. A quick search on google brought up multiple products to review here.

Both of the above mentioned packaging solutions and concepts have been proven to increase compliance.  When patients are presented with the options they not only stay adherent by taking the meds. They stay compliant by not missing doses and ordering and or consenting to their refills at a proper time that allows for proper pick-up or delivery to maintain compliance.  During this crisis with patients quarantined or isolated to socially distance these packaging options greatly improve this important business metric that also goes towards your stores equip score and 5-star rating. 

Other ways of maintaining adherence may come directly from the PMS (Pharmacy Management System) through MTM (Medication Therapy Management) or Med Synch which helps pharmacies provide and align all your meds at one time of the month so as to eliminate multiple therapies (medications) needing to be refilled at various days of the month. Studies have shown multiple trips to the pharmacy to maintain compliance with multiple therapies will fail as an approach to best practice with your health.  Patients will skip maintaining certain meds until the convenient time to get one particular med and then will pick up where they left off in compliance. This leads to bad outcomes and/or additional doctor and possible hospital visits. We at Point of Care Systems handle MTM and patient compliance with our partners at Prescribe Wellness.  If you’d like a demo of how these technologies work together please visit our website here OR schedule a call with us at . Additionally we partner with IVR solutions and Medication Therapy management solutions to further your communication and thus compliance with your patients.

How pharmacists can respond to help patients take medications effectively and prevent worsening health outcomes?

Factors worsening adherence in the COVID-19 era

Perhaps the most visible factor that affects adherence is financial resources.  According to the Kaiser Family Foundation, approximately 49% of the US population has employer-based health insurance. Unfortunately, the economic impact of COVID-19 is well-documented. According to the Bureau of Labor statistics, the number of unemployed persons rose to 23.1 million in April 2020.  Given the number of people who have lost health insurance, this will impact adherence rates by shifting more cost onto patients.  An unfortunate consequence of the COVID-19 pandemic is the avoidance of care for both acute and chronic purposes not related to the virus.  There are multiple factors driving this, including the closing of small primary care practices, reimbursement for telemedicine lagging behind in-person reimbursement, fewer than 20% of visits occurring in person, and the number of primary care physicians dropping from 138,017 to 100,024 since March 2020.  As I’ve highlighted, patients do not take their medicine as prescribed about 50% of the time and approximately 25% of new prescriptions are never filled. Such shortcomings in medication adherence can decrease the effectiveness of a treatment. This increases the likelihood that a condition will worsen, even to the point of death.

These figures fail to consider the numerous challenges patients are now facing during the COVID-19 pandemic, which are making medication adherence significantly more difficult for some patients. Consider the following:

  • Social distancing and stay-at-home orders can discourage patients from leaving their home to pick up medications.
  • Serious complications of COVID-19 are most likely to develop in elderly people and those who are immunocompromised, perhaps due to chronic conditions. These vulnerable populations may be even more hesitant to leave their homes to go to the pharmacy. But it is particularly important that such higher-risk patients maintain adherence to reduce their vulnerability to COVID-19.
  • Public mail carriers will typically leave packages in a mailbox or at a front door without notifying recipients of the delivery. Higher-risk populations may choose not to venture out even to check for delivered medications without assurance that the delivery has arrived. **Report finds significant and increasing delays in prescription drug deliveries under new Postmaster General.**
  • During the pandemic, millions of people have lost their jobs and been furloughed. The financial strain is forcing many people to reevaluate their expenses. Some patients may choose not to fill and refill prescriptions or try to ration and extend the life of a prescription to save money.
  • COVID-19 is exacting a significant toll on Americans’ mental health to the point that the Centers for Disease Control and Prevention (CDC) has a dedicated webpage to stress and coping during the pandemic. When people are struggling mentally, they may also struggle with medication adherence, as a American Kidney Fund survey found: “Forty-two percent of patient respondents said depression, fear, or anxiety had kept them from participating in their daily activities at least once in the previous month.”


Bottom Line for pharmacies on Compliance

Aside from the obvious benefit of good patient outcomes and better health for all. Pharmacies earn their money by primarily filling prescriptions. More prescriptions usually means more opportunities for profit. Every time a patient misses a dose and/or doesn’t recieve refill on-time or properly 7 days prior to the previous fill running out we get into an old-school pharmacy term called ‘creep’.  The idea has always been to give yourself the ability to get ’13’ fills within a 12 month cycle.  Maintenance meds present the perfect long-term opportunity for this.  Maintaining this positive profit cycle is difficult and you must strive to do everything possible by whatever means to achieve this.  Packaging, incentive programs, refill-reminders, multi-dose packaging programs, and customer education programs (like Prescribe Wellnesses “Pharmacy Growth” product) all work effectively. It’s up to each store owner to choose something for your audience and don’t be afraid to change around services if possible until you find what works best for your stores’ customers!!  The Covid-19 pandemic has of course presented a major hurdle in patient compliance throughout health care.  The only way real solution is communication with your customers.  Use the power of your PMS systems’ reporting capabilities to make lists of your largest billing customers and be proactive to call and communicate about what your currently doing for them during the pandemic and get their feedback.  Have your delivery people deliver flyers or store circulars when dropping off prescriptions.  Encourage staff members to also be more engaging when on the phone during this crisis.  Whenever possible keep up the communication with customers. Point of Care Systems RxInsight allows for texting to your entire customer base greatly enhancing your stores own ability to send important refill reminders as well as when customers refills are out! To learn more click here please.

We at Point of Care systems cares deeply regarding the public’s health throughout this pandemic and urge everyone to maintain social distancing and please wear a mask whenever possible.

Additional articles for review:

Abandoned Prescriptions: A Major Concern for the Healthcare System

Managing Star-Ratings Through Medication Synchronization

Isn’t it Time for Pharmacists to Prescribe-Part II

Unit and MultiDose Packaging Solutions


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