Receiving a diagnosis of a chronic condition can be life-changing for a patient. One might imagine they’d be willing to do just about anything to relieve their symptoms and prevent their condition from worsening. However, only 50% of patients who need specialized medications for chronic condition management take their medications as prescribed. As healthcare providers and insurers who are also impacted by nonadherence, it’s essential to understand the connections between chronic conditions and medication adherence and identify the tools that can prevent disease state progression.
The challenges of chronic condition management
First, let’s acknowledge that the term “chronic condition management” recognizes that chronic conditions must be managed. That means time and effort is invested in simply coexisting with a chronic condition. For many patients, that takes adjustment and change which, in itself, can be taxing, physically and mentally. Solid relationships with patients and their care teams, including clinical pharmacists, can help alleviate some of those challenges and connect patients with appropriate support mechanisms.
Exacerbating the stress of a chronic condition diagnosis are the potential healthcare costs. In fact, 90% of the country’s $4.1 trillion annual healthcare costs are attributable to individuals with chronic conditions. In addition to doctor’s visits and other treatments, the high cost of pharmaceuticals required to manage a chronic condition is also a concern and a major cause of medication non-adherence.
An additional challenge to managing chronic conditions is managing not just a care team made up of a variety of specialists and caregivers but also the number and variety of medications prescribed by those specialists. There’s no doubt that medications play an important role in chronic condition management, but ensuring that all are appropriate and avoid contraindications is vital and, in some cases, can be complex.
The role of medication in chronic condition management
While there are a variety of treatment modalities used to help manage chronic conditions, including surgery, physical therapy, radiotherapy, and diet and exercise, prescription medications play an important role in healthcare, especially in the treatment of chronic conditions. Adding complexity, managing multiple chronic conditions simultaneously can require an extensive medication regimen, illustrating the need for clinical experts to help patients manage their health. One example of medication in chronic condition management is diabetic medications. Diabetic patients benefit from a myriad of medications to directly improve their disease management, like insulin, and others to prevent downstream cardiovascular problems, like statins.
Perhaps the clearest sign that specialized medications and their development play an important role in ongoing care is the speed with which they’re being developed today. Those medications are increasingly becoming an important part of a care team’s toolbox and are effective in improving healthcare outcomes for patients with chronic conditions.
The role of clinical pharmacists in chronic condition management
The expertise and importance of clinical pharmacists are often overlooked, despite their vast depth of knowledge as healthcare’s foremost medication experts. For example, as oral oncolytic therapy replaces traditional intravenous chemotherapy treatment methods, new complexities around driving patient adherence and persistence arise. Issues like minimizing medication-medication/food-medication interactions impact patients during the most vulnerable of times and that are the gap that a clinical pharmacist steps into.
From complex multi-medication regimens to understanding proper administration and navigating the uncertainties of high-cost specialized medications, several barriers exist in preventing patients from being their healthiest. There is a clear need for strong patient engagement. Further, the need for highly coordinated, team-based care has never been greater. The Centers for Medicare and Medicaid Services (CMS) is acutely aware of the need for proper medication use to manage chronic conditions. That’s why Medicare Star Ratings include criteria to measure health plans’ performance in maintaining member health, for example, the statin use in persons with diabetes (SUPD) measure. This measure addresses the fact that future disease state progression in diabetic patients can be prevented by simply adhering to their statin medication, a goal that pharmacists can help them achieve.
Clinical pharmacists obviously take on the role of team experts when it comes to managing and optimizing medications to treat chronic conditions. In that respect, they work closely with other providers on the team from doctors and surgeons to nurses and even caregivers. Among their primary, but not often noted, roles is that of relationship builder.
The relationship a clinical pharmacist develops with a patient fosters the kind of trust and honesty a team of caregivers needs to accurately diagnose and treat. They enable a comprehensive and patient-centered treatment plan that connects all parts of the care team to the patient.
How medication adherence impacts chronic condition management
Medication adherence, when it comes to chronic condition management, can be challenging. As noted above, patients with chronic conditions are likely struggling with several factors that can hinder medication adherence including:
- Complex care teams
- Healthcare costs
- Complex conditions with difficult-to-treat symptoms
- Psychological impact and medical fatigue
- Symptoms that impede memory, mobility, and more
- Availability and accessibility of specialized medications
To start, medication adherence is directly tied to better health outcomes when it comes to chronic conditions. Not only that, but medication non-adherence has significant impacts on the chronically ill and can, in worst-case scenarios lead to worsening health or even death. For example, nonadherence in those with cardiovascular disease results in hospitalization rates increasing by 10-40% and the risk of mortality by 50-80%.
The risk to the patient is clear, but those consequences also have a significant impact on caregivers who are tasked with keeping patients healthy. Unfortunately, a patient who cannot adhere to medication schedules or regimens means overburdened caregivers may also lapse in medication management. Overall care is then, again, impacted and health outcomes are at risk. Simply put–medications don’t work if they aren’t taken.
Advantages of a pharmacist-led approach
What is the solution to improving medication adherence in chronic condition patients? A pharmacist-led approach to care. We know that medications are critical to the maintenance of patient’s health and are some of the largest drivers of cost for health plans. Doesn’t it make sense for medication experts (clinical pharmacists) to proactively review and optimize patient medications?
More so than other clinicians, pharmacists possess the in-depth medication knowledge necessary to remove adherence barriers by educating about the benefits, risks, side effects, and interactions of all the medications that a patient is taking. Rather than using a parental or scolding tone, pharmacists take an empathetic, educational approach to patient consultations that build long-term relationships for better care.
Patients with chronic conditions have specialists to help with the management of those conditions such as a cardiologist to treat heart conditions or an oncologist to treat cancer, it’s time to make room on the care team for the top medication specialists, and clinical pharmacists.
