Pharmacists Cut Healthcare Costs

One of the best ways to improve health and save healthcare dollars is to make sure that people with chronic diseases take the medications they should when they should.

It may seem like a funny way to reduce healthcare costs, given the expense of many prescription medications, but for people with chronic health problems, like diabetes, high blood pressure, and high cholesterol, medications often are what helps keep them out of the hospital.

People may lose sight of how important that daily pill is to their good health down the line.

But not everyone takes their medications regularly, even when they know they should. So finding a way to make sure that patients with chronic conditions take the medications they are supposed to can be serious health — and healthcare savings — issues.

There are a lot of different reasons patients fail to follow their doctors' orders about their medication. Worse, patients often discontinue taking them without speaking with their doctor about it.

Sometimes people simply forget their daily dose or they fall behind on getting refills and run out. Others stop taking their medications because they have read or heard worrisome information, making them doubt the safety of their prescriptions. Or a generic pill's appearance changes, and they wonder if they have been given the wrong drug.

If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically…

Sometimes patients don’t really feel any different when they take their pills and wonder whether they need to keep taking them. Particularly when people have chronic conditions that often have no physical symptoms — such as high blood pressure or high cholesterol — they may lose sight of how important that daily pill is to their good health down the line.

Physicians try to encourage patients' compliance with the medical treatment prescribed for them with information, pep talks, pillboxes, nursing visits and other strategies. These vary in success. But what if there was another available resource to help people stay on track?

Pharmacists are under-used, and often under-valued, players in the effort to keep patients on medication, according to a recent study. Enlisting the help of community pharmacies can make a big difference in keeping patients with chronic health problems on their medications and out of the hospital.

The improvement in patients' compliance translated into better health and a savings in health care dollars, without overtaxing the resources of the pharmacies, the study found.

Researchers tested a pharmacy-based intervention with five medications used to treat chronic conditions including diabetes, elevated blood pressure, and abnormal blood cholesterol. The intervention, a guided conversation, was meant to help pharmacists encourage patients to take their medication as prescribed.

Pharmacists in over 100 pharmacies were trained to screen their customers by asking three questions that would help them identify those customers who were at high risk for failing to take their prescription medications as they should.

For comparison, there were also 111 control pharmacies whose customers received standard medication counseling but no targeted behavioral intervention. All in all, over a 12-month period, 50,000 patients were involved as either subjects or members of the control group. Both groups were similar in terms of socioeconomic and health indicators.

As an added incentive, improved compliance with medications could result in more prescriptions being filled which would be financially advantageous to the participating pharmacies.

If a customer in the intervention group was found to be likely to skip taking his or her medication, the pharmacist used a brief, motivational, two- to five-minute conversation to try to encourage them to continue the prescribed treatment.

The results confirmed that the screening and subsequent intervention worked well, with anywhere from three to four percent more patients in the group counseled by their pharmacists taking their medications as prescribed.

The intervention group also had reduced health care costs, specifically in lower emergency department and inpatient hospitalization usage. Health care costs continued to improve as the twelve months study period progressed. This represents significant savings to the health care system and to individual patients and their families.

This successful intervention could be reproduced in other communities, the researchers say. The program was integrated into the normal daily workflow of the pharmacy; additional staff was not needed. Nor did the time taken counseling customers negatively affect the volume of pharmacy work. As an added incentive, improved compliance with medications could result in more prescriptions being filled which would be financially advantageous to the participating pharmacies.

Community pharmacies are an “untapped resource” that can be harnessed and used to improve public health and reduce overall health care costs, said researcher Janice Pringle, the director of the Program Evaluation and Research Unit the University of Pittsburgh's School of Pharmacy.

“If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically, and the risk for severe health problems, such as heart attack or stroke, would be reduced. Patients would live longer and probably enjoy a higher quality of life.”

The study highlights one of the ways existing community resources can be used to improve individual and community health and address spiraling healthcare costs. It is published in Health Affairs.