By Melissa Odorzynski, PharmD, MPH
One of the earliest lessons I learned as a young pharmacist, working at a community mental health center in Madison, Wisconsin, was how critically important it is for people with behavioral health issues to stick with their medication plan, also known as medication adherence.
A seasoned nurse vividly described it this way: If a person with high cholesterol forgets to take cholesterol medication for a few days, the likelihood of having a heart attack immediately is relatively low. But a person with schizophrenia who misses anti-psychotic medication for even a short time is at imminent risk of relapse and hospitalization.
The National Council for Behavioral Health this week published a comprehensive report on the topic on medication adherence, entitled “Medication Matters: Causes and Solutions to Non-Adherence.” I was honored to serve on an expert panel that contributed to the report, and I look forward to speaking on this topic at the American Psychiatric Association’s Mental Health Services Conference on October 4 in Chicago.
One of the key takeaways from the report is that pharmacists are a critical, and often untapped, resource for improving medication adherence for individuals with behavioral health and other complex, chronic conditions.
A number of the report’s recommendations for improving adherence for these populations – directed at government, payers, providers and advocates – specifically call for greater involvement by pharmacists and pharmacy services. In fact, many of those recommendations are already being successfully deployed in our pharmacies and Medication Management Solutions telephonic care center. They include:
- Expand the role of pharmacists. Specifically, the report recommended team-based care management that include pharmacists, and called for pharmacists to be allowed to administer injectable long-acting medication for mental illness and substance use disorder.
- Improve communication. According to the report, pharmacists trained in motivational interviewing, which promotes behavior change, can help promote adherence when providing medication management services.
- Establish in-house pharmacies. Onsite pharmacies, like the ones Genoa Healthcare has within hundreds of community mental health centers nationwide, improve access to pharmacy care, significantly improve adherence rates, reduce hospitalization and emergency care, and decrease total cost of care.
- Maximize the use of tools such as bubble-pack dispensing. The report cited case studies showing how such tools have proven successful for managing complicated medications regimens.
The high prevalence of non-adherence among individuals with behavioral health conditions is well documented. The report cites multiple adherence studies, including in the field of behavioral health, and concludes that “non-adherence is a significant problem across all health care delivery systems and settings and represents a major health problem.” The serious implications of non-adherence are also well known among those with behavioral health conditions, including greater risk of relapse, disruption in work and social life, hospitalization, and tragically, even suicide.
Many of us in this field well understand the reasons why people slip into non-adherence, which often go well beyond simply forgetting. They include perceptions of mental illness, complexity of the drug regimen, inability to keep appointments due to transportation and other challenges, and more. The work we do at Genoa Healthcare seeks to address those challenges. We know firsthand that better medication adherence improves healthcare outcomes.
The National Council’s report doesn’t pull any punches on the need to find ways to improve adherence, calling it “arguably the greatest opportunity to improve treatment outcomes and achieve cost savings in our healthcare system.”
Pharmacists are on the front lines, interacting day in and day out with individuals living with complex, chronic conditions, including mental illnesses and substance use disorders. We are uniquely positioned to identify and address barriers to medication adherence, although we are often underutilized. It is important – and exciting – that pharmacists are increasingly being recognized as a critical part of the solution.