Tailored Pharmacy-Based Interventions to Improve Medication Adherence
Medication nonadherence is when a patient has a hard time taking a prescribed medication or following the doctor’s instructions. Barriers that prevent patients from taking their medications can appear at the patient, provider, or health system level. Nonadherence is associated with uncontrolled blood pressure and higher rates of hospital admissions.2
The Pharmacists’ Patient Care Process was established by the Joint Commission of Pharmacy Practitioners to help pharmacists deliver patient care and services in a consistent way.3
In The Community Guideexternal icon, the Community Preventive Services Task Force (CPSTF) recommends tailored pharmacy-based interventionsexternal icon to help patients take the medications prescribed to them to help prevent cardiovascular disease.1
Public health practitioners and state and local health departments can support use of the CPSTF findings by promoting tailored pharmacy-based interventions and helping community pharmacies with implementation.
Tailored pharmacy-based interventions aim to help patients who are at risk for cardiovascular disease take their medications as prescribed. Interventions include the following:
- Assessment—Interviews or assessment tools are used to identify adherence barriers (things that get in the way of patients taking their medications as prescribed).
- Tailored guidance and services—Pharmacists use the results of the assessment to develop and deliver tailored guidance and services that aim to reduce patients’ barriers.
- Guidance includes focused medication counseling or motivational interview sessions.
- Services include one or more of the following: patient tools, such as pillboxes, medication cards, and calendars; medication refill synchronization; and enhanced follow-up.
Interventions may be set in community or health system pharmacies. They may include additional components, such as patient education materials or communication between the pharmacist and the patient’s primary care provider. Interventions may be used alone, or they may be part of a broader intervention to reduce patients’ cardiovascular disease risk.
Strategies that Support the Pharmacists’ Patient Care Process and Tailored Pharmacy-Based Interventions
The Joint Commission of Pharmacy Practitioners developed the Pharmacists’ Patient Care Processexternal icon to address medication nonadherence for chronic diseases. Strategies that support the Pharmacists’ Patient Care Process include medication therapy management, the appointment-based model, collaborative practice agreements, and text messaging.
Tailored, pharmacy-based interventions may be implemented as one component of the broader Pharmacists’ Patient Care Processpdf iconexternal icon. Steps in the process (collect, assess, plan, implement, follow-up, and monitor) closely align with the process for selecting tailored actions to remove or reduce patient adherence barriers.
- Medication therapy management (MTM) includes a broad range of health care services provided by pharmacists, who are the medication experts on a patient’s health care team.4 It allows pharmacists to actively manage patients’ medications and identify, prevent, and resolve medication-related problems. This support helps patients get the most benefit from their medications. MTM services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs, and many other clinical services.
- The appointment-based model (ABM)5 is a patient-focused care model that can help patients take their medications, make a pharmacy’s workflow more efficient, and prevent problems before patients arrive at the pharmacy. Patients enrolled in the ABM have a designated appointment day to pick up all medications. Pharmacy staff call patients before their appointment to identify any changes to their medications and confirm that each prescription should be refilled. The ABM shifts the pharmacy staff’s focus from passively filling prescriptions at the request of the patient on an unaligned schedule to proactively synchronizing a pick-up date for chronic medicines.5 Staff also review the patient’s medications each month to ensure that they are getting the correct medications and to identify any potential problems. Most national and regional chain pharmacies and many independent community pharmacies have adopted the ABM and medication synchronization.5
- A pharmacist collaborative practice agreement (CPA)6 is a formal agreement in which a licensed health care provider makes a diagnosis, supervises patient care, and refers patients to a pharmacist under a protocol that allows the pharmacist to perform specific patient care functions, such as renewing prescriptions once refills have expired, modifying medication therapy according to the protocol, and ordering lab tests.
- Text messaging7 is available on mobile devices and is used widely by people in all age and socioeconomic groups. It can be used to communicate health information to patients to improve medication adherence. The benefits and considerations of each of these strategies are outlined in the table below.
Table 1. Pharmacists’ Patient Care Process
|Pharmacists’ Patient Care Process|
|Medication therapy management (MTM)4||
|Collaborative practice agreement (CPA)6||
The tools and resources listed in this section offer steps that public health practitioners and state and local health departments may take.
Identify patient populations that need help. For example, practitioners and health departments can
- Map populations with high medication nonadherence rates.
- Measure medication adherence in a population with high blood pressure. The proportion of days covered (PDC) is the leading method used to calculate medication adherence at the population level. A population is considered adherent if 80% of people have access to their medications for at least 80% of days in a defined study period (e.g., 80% of 365 days).
- Interactive Atlas of Heart Disease and Stroke
This CDC interactive mapping resource provides data and filter options, including social and economic data, county-level blood pressure medication nonadherence, number of pharmacies and drug stores, and Medicare beneficiaries with heart disease.
- Calculating Proportion of Days Covered (PDC) for Antihypertensive and Antidiabetic Medicationspdf icon
This CDC evaluation guide helps state recipients and data analysts assess and calculate PDC, which is the preferred method for calculating medication adherence. This guide provides information on how to identify a data analyst with the appropriate skills, obtain access to data, prepare analyses, calculate the PDC, and report results.
- GIS Example: South Dakota Blood Pressure Medication Nonadherence
This state-level example uses GIS to identify target areas for heart disease prevention efforts related to medication nonadherence in South Dakota. It is part of a CDC GIS Capacity Building Project.
Assess facilitators and the barriers to implementing tailored pharmacy-based interventions. For example, practitioners and health departments can
- Determine what factors help patients access and enroll in pharmacies that provide MTM, ABM, or medication synchronization—and what factors prevent access.
- Methods & Resources for Engaging Pharmacy Partners pdf icon[PDF – 765 KB]
This CDC guide describes how health departments can establish or expand pharmacy services. The information is summarized in a Coffee Break webinar pdf icon[PDF – 1 MB].
- Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists pdf icon[PDF – 633 KB]
This CDC guide provides information about current resources and emerging practices, as well as tools and examples that pharmacists can use to help them improve health outcomes associated with cardiovascular disease.8
- A Program Guide for Public Health: Partnering with Pharmacists in the Prevention and Control of Chronic Diseases pdf icon[PDF – 389 KB]
This CDC guide is for state health departments and communities that want to build or maintain existing relationships with pharmacists and other stakeholders. It includes basic definitions, information about the role of a pharmacist in team-based care, information about scope of practice laws, state health department examples, and strategies to consider.
Act to implement tailored pharmacy-based interventions with strategies that complement the CPSTF recommendation. For example, practitioners and health departments can
- Share information with pharmacy partners and support ABM and medication synchronization.
- Promote team-based care through MTM and other tailored pharmacy-based interventions.
- Pharmacy’s Appointment-Based Model pdf icon[PDF – 1 MB]external icon
This American Pharmacists Association (APhA) Foundation implementation guide has five modules: Introduction, Gaining Organizational Support, Developing the Operational Plan (includes sample documents), Sharing Benefits, and Integrating Technology and Data Monitoring. It also includes stories from the field.
- MTM Libraryexternal icon
This APhA portal contains tools for starting or improving MTM services.
- Advancing Team-Based Care Through Collaborative Practice Agreements pdf icon[PDF – 4 MB]
This CDC resource and implementation guide defines collaborative practice agreements, provides information about state laws and other factors to consider, and provides a template for drafting a sample agreement.
- Field Notes: HealthPartners Pharmacy Program pdf icon[PDF – 714 KB]
- Case Study: Team-Based Care in Arizona, Georgia, Iowa, Utah, Virginia, West Virginia, and Wyoming pdf icon[PDF – 475 KB]
- Field Notes: University of California, San Diego (UCSD) Pharmacy Program pdf icon[PDF – 782 KB]
- Field Notes: Michigan Medicine and Meijer Pharmacy Program pdf icon[PDF – 604 KB]
- MTM Profilesexternal icon
Website addresses of nonfederal organizations are provided solely as a service to our readers. Provision of an address does not constitute an endorsement by the Centers for Disease Control and Prevention (CDC) or the federal government, and none should be inferred. CDC is not responsible for the content of other organizations’ web pages.
- The Community Guide. (2019). Cardiovascular disease: tailored pharmacy-based interventions to improve medication adherenceexternal icon.
- Centers for Disease Control and Prevention. CDC Grand Rounds: improving medication adherence for chronic disease management — innovations and opportunities. MMWR 2017;66(45).
- Joint Commission of Pharmacy Practitioners. (2019). The Pharmacists’ Patient Care Processexternal icon.
- American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0 pdf icon[PDF – 1 MB]external icon. Washington, DC: American Pharmacists Association and National Association of Chain Drug Stores Foundation; 2008.
- American Pharmacists Association Foundation. Pharmacy’s Appointment-Based Model: Implementation Guide for Pharmacy Practices pdf icon[PDF – 565 KB]external icon. Washington, DC: American Pharmacists Association; 2013.
- Centers for Disease Control and Prevention. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team pdf icon[PDF – 2 MB]. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2017.
- Thakkar J, Kurup R, Laba TL, Santo K, Thiagalingam A, Rodgers A, et al. Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysisexternal icon. JAMA Intern Med 2016;176(3):340–349.
- Centers for Disease Control and Prevention. Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists pdf icon[PDF – 1.5 MB]. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2016.