Taking medications as directed is crucial for treatment success, but it is not always easy for patients to be adherent to their medications. Medication non-adherence is a serious problem and can lead to further health complications. It is often thought of as a result of patients being on too many medications or not fully understanding the important role these medications play in their health. Although this is true- 3 out of 4 people do not take their medications as directed– an often overlooked explanation of non-adherence are social determinants of health.
What are social determinants of health?
Social determinants of health (SDoH) are factors in an individual’s life that determine the amount of healthcare they will receive. Examples of social determinants can be seen in the image below, but the ones that play an especially important role in medication adherence are:
- Economic stability
- Access to healthcare
- Education
While these three SDoH affect a patient’s ability to obtain the medications they need, there are ways that pharmacists can assist in overcoming these barriers.
Source: https://www.sunshineclinic.org/blog/social-determinants-of-health/
Economic Stability
If a patient does not have the ability to pay for their medication, the chances are they will not be picking it up from your pharmacy, leading to the downward spiral of non-adherence, further health complications, and so on. Many medications for chronic disease states, such as diabetes and arthritis, can be very expensive if paid for “out-of-pocket”. There are ways that pharmacists can help with these “out-of-pocket” costs, such as recommending a GoodRx coupon or looking for a patient assistance program (PAP). PAPs can be found on manufacturer’s websites or at NeedyMeds. Additionally, if the issue is that the medication is not on the patient’s insurance formulary, pharmacists can look into what medication would be covered and recommend this to the prescriber. Prescribers really appreciate when a pharmacist goes the extra mile because this saves the prescriber time and shows that the pharmacist wants to be involved in the patient’s care!
Source: https://vbidcenter.org/initiatives/precision-patient-assistance-2/
Access
According to the American Hospital Association (AHA), over 3 million people in the United States do not receive medical care due to a lack of transportation. Many factors can affect an individual’s access to healthcare such as their age and location. If a patient cannot get to the pharmacy to pick up their medication, how are they going to be adherent? As pharmacists, it is important to let our patients know of convenient ways they can obtain their medications, such as mail order pharmacies and local delivery services provided by retail pharmacies. To reduce the number of trips to the pharmacy, we can recommend 90-day prescriptions and medication synchronization. Convenience can increase medication adherence, so it is a good idea to offer these services to all of your patients!
Education
Less education is linked to lower income, which is linked to worse health outcomes. Patient education is one of the most important ways that a pharmacist can get involved in a patient’s health- we are trained medication counselors! It is important for pharmacists to make sure the patient understands why they are taking their medications, how they should take them, and what they should expect (side effects, adverse drug reactions, etc.) It is easy to assume that the patient’s prescriber discussed this with them, and even if they did, it wouldn’t hurt to go over this information a second time! Most of the time, as healthcare providers, we tend to use “medical jargon” in our daily vocabulary. Not every patient will have the same level of education, so it is important to be simple and concise when speaking to patients about medications or disease states to ensure that they understand you. For example, “hypertension” should be referred to as “high blood pressure.” The more the patient understands, the more likely they will be adherent!
What else can pharmacists do to address this issue?
A service that has recently become more popular is Medication Therapy Management (MTM). Pharmacists can play a key role in advocating for medication adherence by performing a comprehensive medication review with the patient by gathering a complete list of all of the medications a patient is taking (prescription, OTC, and herbals). Through the MTM service, a pharmacist may find out information about the patient that they didn’t know before, such as a lack of transportation. By reviewing medications, pharmacists can also catch drug-drug interactions and improper medication use. MTMs are a great way to learn more about your patients to optimize their treatment, and by receiving this special attention from their pharmacist, a patient may be more likely to be adherent to their medications.
Pharmacists tend to have a creative mindset when it comes to suggesting ways a patient can remember to take their medications, such as:
- Simplifying dosing regimens (combo medications, once-daily dosing)
- Pill boxes
- RxTimerCap
- Alarms
- Smartphone apps
- Pharmacy-generated text messages/phone calls
- Putting the medication next to an item that is used every day (such as a coffee pot)
There are also organizations that are creating ways to increase medication adherence, such as the Script Your Future campaign.
Script Your Future (SYF) provides tools for individuals to remember to take their medications and manage chronic disease states. This campaign was created by the National Consumers League (NCL) in 2011 with partners in various areas of healthcare. Each year, the SYF campaign conducts a two-month challenge among pharmacy schools in which the schools will compete by advocating for medication adherence through community outreach initiatives. During this challenge, patients can fill out “pledge cards” and pledge to take their medications as directed. They also provide materials and tools to share with your patients.
So are social determinants of health the only barrier to medication adherence? The answer is no, but they definitely play a huge role in this crucial problem. Pharmacists can actively participate in a patient’s health care by keeping an eye out for these barriers and encourage patients to take their medications as directed!
References:
- About. Script Your Future. (n.d.). Retrieved March 16, 2022, from https://scriptyourfuture.org/medication-adherence/
- Align my refills. APhA Foundation. (2016, May 23). Retrieved March 16, 2022, from https://www.aphafoundation.org/align-my-refills/about-medsync#:~:text=Medication%20synchronization%20is%20when%20the,more%20likely%20to%20take%20them.
- Google. (n.d.). Helping patients afford their medications.pdf. Google Drive. Retrieved March 16, 2022, from https://drive.google.com/file/d/13745aae59xp1FnHdgzPlpCQx1cvS9IkM/view
- Medication therapy management (MTM). APhA Foundation. (2013, October 10). Retrieved March 14, 2022, from https://www.aphafoundation.org/medication-therapy-management
- “Pledge.” Script Your Future, https://scriptyourfuture.org/about/.
- Petram, T. (2019, April 2). What are social determinants of health. Sunshine Community Health Center. Retrieved March 13, 2022, from https://www.sunshineclinic.org/blog/social-determinants-of-health/.
Bryanna is a current pharmacy student at the Wilkes University Nesbitt School of Pharmacy and is expected to graduate in May of 2023. Bryanna’s primary pharmacy-related interests are managing chronic disease states, medication adherence, substance abuse disorder, vaccine confidence, and ambulatory care pharmacy. She has been working as a pharmacy intern at Rite Aid for 3 years and enjoys making a direct impact on the community through administering vaccinations and dispensing prescriptions. Bryanna is currently serving as the Wilkes University Script Your Future Social Media Outreach Chair and has been working with faculty and students to create outreach events to educate the community about medication adherence among various other topics in health care. During her free time, she loves cooking, reading, and going to concerts.
Bryanna Polascik, PharmD Candidate 2023
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