Two new studies suggest that the use of technology-based solutions can improve patients’ adherence to prescription medications. It can also build stronger relationships between patients, their physicians and pharmacists. The net effect is better health for patients and better business health for pharmacies.
“It may sound counter-intuitive, but technology actually can increase communication between patients and their prescribers and pharmacists,” says Tony Willoughby, chief pharmacist at Health Mart, a McKesson affiliate.
The first study, by health services researchers at the University of Pittsburgh School of Pharmacy and the University of Wisconsin School of Pharmacy, examined what older adults thought of e-prescribing and how e-prescribing affected their medication adherence.
The study, published in January in Perspectives in Health Information Management, was based on a phone survey of 75 adults aged 50 or older who were heavy prescription drug users: 44 percent of the respondents were taking one to three prescription medications; 36 percent were taking four to six prescription medications; and 20 percent were taking more than six prescription medications.
Patients Equate E-Prescribing with Better Care
Some 81.3 percent of the patients preferred electronic prescriptions to paper prescriptions, and 76 percent said their physicians did, in fact, send their prescriptions to their local pharmacy electronically. More importantly, nearly 30 percent said e-prescribing improved their adherence to medication, and more than 60 percent said e-prescribing improved the care they received from their pharmacists.
The use of e-prescribing technologies removes a number of steps along the traditional prescription-filling process that create opportunities for non-adherence, according to Health Mart’s Willoughby.
“When done right, e-prescribing can actually increase communication between patients and their prescribers and pharmacists, and increased communication can improve adherence,” Willoughby says.
For example, a prescriber can use e-prescribing technology to check a patient’s drug formulary and start a discussion with the patient about drug options, Willoughby says. A prescriber also can use e-prescribing technology to check a patient’s prescription for interactions with other drugs, creating another opportunity to communicate directly with that patient, he adds.
“That back-and-forth dialogue will increase the level of connection with the prescriber and increase the level of influence the pharmacist has on the patient’s health behaviors,” Willoughby says.
The researchers agreed with the assessment, concluding: “E-prescribing may also influence medication-related behaviors through patient perception of increased convenience, an increase in reported discussions about medication with providers, and patient perception of improved quality of care.”
The second study—by health services researchers at several prominent health systems, including Brigham and Women’s Hospital in Boston; Geisinger Health System in Danville, Pennsylvania; and Sutter Health in Sacramento, California—looked at the impact of telephone interventions on patients who didn’t pick up their first-time prescriptions to treat asthma, high blood pressure, diabetes and high cholesterol.
This study showed e-prescribing enables pharmacists to have an impact on primary medication non-adherence. Willoughby explains that a patient’s pharmacist would be unaware of any new paper-based prescriptions. With e-prescribing, prescriptions are sent directly to the pharmacy. The pharmacist is immediately aware of the new prescription and can take appropriate interventions to decrease primary non-adherence.
The study, published in February in the Journal of Managed Care & Specialty Pharmacy, found that telephone interventions—a series of up to three calls from a nurse call center—had little impact on the adherence rates of 290 patients who didn’t pick up their prescriptions within 14 days. Some 25 percent of 142 patients who received the interventions picked up their prescriptions compared with 24 percent of the 148 patients in the control group who didn’t receive the interventions.
E-Prescribing Prompts and Follow-ups Improve Adherence
More noteworthy, however, was the fact that there were only 290 people who didn’t pick up their prescriptions within 14 days, according to Willoughby, who pointed to the effectiveness of the e-prescribing systems of the health systems and retail pharmacies involved in the study.
Of the initial 4,822 patients in the study, 4,532 patients, or 94 percent, picked up their prescriptions within 14 days. Just 290, or 6 percent, did not. That’s less than half of the 15 percent to 20 percent rate seen in other primary non-adherence studies.
The researchers cited an e-prescribing feature built into the prescribing providers’ EHR as a possible explanation for the high pickup rate. A prompt in the EHR asked the prescribing provider to rate the likelihood of the patient picking up his or her prescription from the designated pharmacy. That actionable information was conveyed to the designated pharmacy, which used a series of two automated voice phone call reminders and one live phone call reminder from a pharmacist.
“More consistent use of e-prescribing and use of only one pharmacy chain with a pre-existing pharmacy fill outreach program also present mechanisms for this unexpectedly high first-fill rate,” the researchers said in their study.
“This program takes a proactive, clinical approach to the patient,” Willoughby says. “When the pharmacies saw the medication order come through and didn’t hear from the patient, they would make two automated calls and then a personal call. The pharmacist invested his or her personal time to answer the patient’s questions or concerns. And the intervention decreased non-adherence to just 6 percent.”
Better Business Health for Pharmacies
In addition to better health for the patient, e-prescribing has a business impact on the pharmacy, according to Willoughby. E-prescribing increases the efficiency of filling and refilling prescriptions, which lowers operating costs, he says. Additionally, when e-prescribing improves patients’ medication adherence, more prescriptions are filled and refilled, and that increases pharmacy revenues, he says.
As the new studies show, the return on investment in e-prescribing technologies is both clinical and financial. Both patients and pharmacies benefit.