October 9, 2019
Today, 66 percent of adults in the U.S. use prescription drugs, and the proportion is even higher among those with a chronic condition. As the benefits of integrated care become more apparent and new therapeutics continue to be introduced, the role of a pharmacist has evolved beyond that of merely a dispenser of medication. What seemed simple decades ago – diagnosis followed by prescription – has been transformed with the understanding that a different approach is needed to ensure patients are getting the best outcome from their medications.
For example, adhering to the recommended dosage is vital, yet nearly half of those with a chronic condition don’t take their medication as prescribed, and, overall, individuals prescribed self-administered medication usually only take half the dosage. The New England Journal of Medicine estimates that non-adherence costs $100 to $290 billion a year. Not taking the appropriate dosage makes drugs less effective and can have life-threatening consequences including increased complications, increased hospitalizations and, in some cases, death.
To promote improved medication practices, close gaps in care and improve patient health, Blue Cross & Blue Shield of Rhode Island (BCBSRI) has embedded pharmacists as part of an integrated care team in patient-centered medical homes across the state through their Patient-Centered Pharmacist Program. The embedded pharmacists provide services including comprehensive medication reviews, case management and disease management. They are also working directly with patients to help them understand their medication and potential side effects.
By being present at the site of care, the pharmacist has immediate, direct access to patients and builds a rapport with both the patient and doctor to gain a better understanding of the patient’s needs. Patients can ask questions and share concerns regarding their treatment before leaving for home.
“Working closely with both the patient and physician, the pharmacist can advocate to make sure the right medications are prescribed and that the patient understands the dosage as well as potential side effects,” said Mike Kolodij, PharmD, who heads pharmacy programs at BCBSRI. “With many patients requiring long-term, complex medication regimens, having this level of coordinated care is improving outcomes and lowering costs.”
The increased patient engagement doesn’t stop when the patient goes home. The pharmacists make weekly check-in calls to the patient. Through these checks, they can detect concerns or complications and recommend adjustments to the dosage or therapies if necessary.
“The weekly calls and pharmaceutical follow-up are saving lives,” added Kolodij. “Our pharmacist reached out to a patient to discover they had not been taking their anticoagulant as prescribed and had developed life threatening blood clots. Without that call, who knows what would have happened to the patient.”
The pharmacists are also intimately familiar with prescription drug insurance coverage and can provide insight to the doctors as they are prescribing, ensuring that patients receive the right medication at the most affordable price.
The program has worked as intended: It’s keeping people on their medicine and helping them stay healthier. Since its start in 2014, the number of patients receiving a comprehensive medication review has jumped from 19 to 82 percent. Additionally, medication adherence rates for patients taking medication for diabetes, hypertension and cholesterol has climbed to 85 percent or greater – up from 76 percent before the program began.