US Pharm. 2016;41(12):1.

Various research studies conclude that the issue of prescribed-medication noncompliance costs the U.S. healthcare market more than $300 billion annually, finding that almost two in three patients do not take their medications as prescribed by their physicians. As reported by Helen Figge, PharmD, MBA, in this issue’s TechRx column, healthcare stakeholders, such as pharmacists and payers, who seek to address this important issue have seen limited success.

A possible solution, she writes, may be relegating a patient’s medication refills to a specific day of the month, enabling pharmacists to add structure and consistency to dispensing. Consolidating all of a patient’s monthly maintenance prescriptions to a given day and providing patients the convenience of a single monthly medication(s) pickup are attractive aspects. This tracking exercise, Dr. Figge points out, also strengthens the bond between pharmacist and patient, who must work together to plan how the patient can better adhere to his or her medication regimen.

This type of medication adherence program also supports the pharmacist in a consultative role with the patient, encouraging compliance. For example, as Dr. Figge writes, pharmacists can monitor all of a patient’s long-term, chronic-disease prescriptions, building a cornerstone of stronger compliance and adherence. Moreover, this back-and-forth reinforces the consultative role that pharmacists are embracing, leading ultimately to the long-standing goal of provider status.

Further standardizing the medication synchronization concept, some technology companies are getting into the game by offering “med sync” software. Refill synchronization, also called med sync, is emerging as a tool for retail pharmacies to better manage patient compliance and cost. Pharmacists, Dr. Figge adds, have the opportunity to build relationships with their patients and, in turn, not only improve medication adherence, but also provide quality care through med sync programs. One med sync suit might not fit all, however, and pharmacists should identify appropriate patients for participation. Patients who are on monthly refills of long-term medications would benefit the most, she adds.

A class of drugs particularly subject to the success or failure of adherence and compliance is medication for gastroesophageal reflux disease (GERD). Perhaps the most effective acid-suppressive medications against GERD are the proton pump inhibitors (PPIs), which irreversibly bind the gastric acid pump of the stomach’s parietal cells. PPIs offer quicker symptom relief and better long-range healing of erosive esophagitis than antacids, histamine2-receptor antagonists (H2RAs), or prokinetic agents.

As Jennifer Confer, PharmD, BCPS, BCCCP, and Yasmine Zeid, PharmD Candidate 2017, write in this issue’s feature article “Pharmacologic Management of GERD,” PPIs should be taken once daily approximately 30 to 60 minutes prior to the first meal of the day to assure maximum efficacy and, if possible, should not be taken at bedtime owing to lesser efficacy then. This regimen invites close consultation with the pharmacist, as fine-tuning is sometimes needed: Patients who do not experience relief with a once-daily PPI dosage may benefit from twice-daily dosing.

At the top of the list of reasons for PPI failure are noncompliance and improper timing of doses, they write. (Other culprits include weakly acidic reflux, delayed gastric emptying, nocturnal reflux, esophageal hypersensitivity, residual acid reflux, and reduced PPI bioavailability.) In addition, with the migration of some PPI products to OTC status, the need for pharmacist expertise is greater than ever to avoid adverse drug reactions stemming from patients managing their own treatment.

Strong consensus exists that medication adherence is the foundation of cost-effective healthcare and an ideal pathway to provider status, as the pharmacist is in the best position to influence outcomes. Medication synchronization and the appointment-based model might offer the pharmacist the opportunity for more patient engagement while also allowing for greater healthcare quality gains.

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