A Pharmacy Counseling and Postdischarge Intervention to Improve Initial Adherence for High-Risk Medications

Background/Aims: Poor medication adherence to potentially life-saving prescriptions frequently inhibits appropriate treatment and outcomes, particularly concerning new drugs following hospital discharge. Yet such initial adherence signals an opportunity to implement effective patient-centered care, balancing clinical objectives with patient health beliefs and other considerations. Within quality improvement efforts of a pharmacy counseling program for high-risk medications, we utilized a short adherence questionnaire and follow-up contact with patients to determine factors associated with initiating anticoagulant regimens. Methods: Consecutive adults discharged from Scott & White Hospital between February and December 2013 receiving new prescriptions for Plavix, Effient, Brilinta, Pradax, Xarelto or Coumadin were recruited. Per program guidelines, a pharmacist counseled inpatients concerning their prescriptions, discussed benefits and side effects, and helped resolve immediate adherence problems. Individuals were next administered a validated 3-item Likert instrument as a brief, proximal screener for adherence propensity targeting specific barriers on medication trust, perceived effectiveness and out-of-pocket drug costs. Following consent, participants were contacted within 3 days to provide demographics and confirm they filled initial prescriptions, commenced treatment and intended to remain adherent. If not, self-reported reasons for not taking medications were solicited. Descriptive and bivariate analyses documented associations between patient characteristics, perceived barriers, and upon initial adherence behavior. Results: Slightly over half of the 101 patients contacted (96% response rate) were prescribed Plavix, with other medications equally distributed; participants averaged 70.1 years, were 60% male, 26% minority and 12% uninsured. The mean medication trust score was 4.7 (of 6), indicating positive drug perceptions, as did the 4.8 average for gauging prescription importance. However, mixed experiences were reported for personal drug costs (3.6 mean). 94% both filled initial prescriptions and intended to keep taking them. Minimal self-reported barriers included costs or forgetting to visit the pharmacy, yet far greater numbers enthusiastically supported the counseling program and follow-up contact. Discussion: While the brief screening instrument did not identify patients likely to experience adherence problems (costs excluded), the predischarge counseling program exemplifies a successful transition engagement as patients initiate essential treatment. Since prior work demonstrates that highly activated individuals adopt better self-care behaviors, including adherence, such educational patient-centered interventions can promote healthier decisions and better outcomes