Many diseases are treated by medication, yet studies have shown that approximately 50 percent of patients do not take medications as prescribed. St. Luke’s is focused on improving outcomes and lowering the total cost of care, and clearly, improvement in medication compliance and adherence has the potential to reduce costs and improve outcomes.
So St. Luke’s is piloting a program to achieve just that. Here is my guest blogger, St. Luke’s Communications Coordinator Chereen Langrill, to explain what we’re doing to improve medication compliance.
- David C. Pate, M.D., J.D.
Repeat business is usually an indication of commercial success. For hospitals, it is cause for concern.
Hospital readmissions are costly for both patients and hospitals, can impact a hospital’s quality rating and put patients at risk for complications and infections.
Meds2Beds is a new program at St. Luke’s Meridian that aims to reduce hospital readmissions by getting in front of medication errors, which are a significant cause of readmissions. The term Meds2Beds is used within the pharmacy community; through St. Luke’s program, medication is delivered to patients’ bedsides before they leave the hospital, along with detailed instructions from pharmacy representatives and educators, which reduces the chance for medication errors later. Patients also can get help with questions regarding insurance coverage or payments.
The program started in January 2016 as a pilot focusing on people with chronic obstructive pulmonary disease (COPD). The concept for the program began to bloom with the help of Dr. Jennifer Shalz, medical director for St. Luke’s Heart Health and Rehabilitation and co-chair of a committee to improve COPD care. There was a gap in care for patients who weren’t using their medications correctly and getting readmitted because of it, and Dr. Shalz approached Mike Griffiths, director of pharmacy for St. Luke’s Boise and Meridian, to find a solution.
“We go the extra mile, work with insurance companies, make sure we do pre-authorization and make sure they know how to use their medication properly,” Dr. Shalz said. “Every inhaler is used differently. That is a good illustration of why it is important to have this extra support, because it is easy to use medication improperly even when you think you are using it right.”
Although similar programs can be found at some other hospitals, it is still a young concept, Griffiths said. At Intermountain Medical Center in Utah, for example, the program is offered on a limited basis for some patient populations, such as surgery, cardiovascular and maternity. Because each hospital program is unique, St. Luke’s program wasn’t modeled after any other specific program.
“We are among the first hospitals to implement this innovative program,” Griffiths said.
The program, subsequently expanded to include heart failure patients, got another boost early this year when a dedicated full-time pharmacist and technician joined on. The team, based out of St. Luke’s Meridian Outpatient Pharmacy, is composed of technicians Clark Brenisholtz and Colleen Jenkins and pharmacists Darcy Aslett and Layne Tominaga, who share the full-time position.
“My role and my focus is to help a patient realize they aren’t alone in this,” Aslett said.
Griffiths understands why patients face challenges when trying to take medication as prescribed. Patients can be discharged with a dozen or more prescriptions. They are consumed by concerns about who will care for them at home and how they will sort out questions regarding insurance while still recovering from a hospital stay.
“They’re overwhelmed,” Griffiths said. “They’re lost. We try to remove some of that burden from them.”
COPD patients are especially vulnerable for readmission – 20 percent are readmitted within 30 days of leaving the hospital – and the cause is often connected to medication errors or the inability to afford their medication, according to Griffiths. A return visit to the hospital can cost a COPD patient $40,000. When COPD patients are readmitted to the hospital, it accelerates the progression of their disease and also increases the chance of death, according to Dr. Shalz.
Problems with medications are troublingly prevalent. Statistics show that 50 percent of individuals don’t take medication correctly, and 25 percent never fill a prescription after leaving the hospital. Some make a conscious decision not to fill a prescription because it is costly and won’t be covered by their insurance. Griffiths said some people try to stretch their medication by taking it in smaller doses, which can trigger medical problems requiring hospitalization.
Griffiths recalled a story that illustrated the slippery slope patients face when navigating their care post-discharge. A woman checked on her neighbor two days after he returned home from the hospital. He told her that his arm felt hot. She asked if his doctor had prescribed any medication. He said he wasn’t sure. Because of the woman’s help, the man was able to get the medication he needed. If he had waited until his follow-up visit, scheduled for two days later, he would have had an infection that would have required hospitalization and intravenous drugs, and he would likely have faced a hospital bill for at least $10,000.
“When you leave the hospital, you aren’t feeling good,” Griffiths said. “You don’t want to go to the drug store and wait. Some people decide to fill their prescriptions later, and then they just forget. Sometimes they end up paging their physician late at night or end up back in the emergency room because their pain is out of control or they are experiencing other medication-related complications.”
The program works like this: a St. Luke’s pharmacy technician visits the patient’s room before they are discharged from the hospital and explains the bedside delivery service. Patients learn that there is no additional charge for the program, and that they have the option of transferring future prescriptions back to their original pharmacy. If the patient agrees to participate, a pharmacist or pharmacy technician processes the prescription(s), working with the physician to resolve any insurance issues, and then returns with the prescriptions. The pharmacist explains in detail how to take the medication.
Staff from St. Luke’s Meridian’s Outpatient Pharmacy perform multiple functions to make the program successful. They must be detectives, educators and counselors to solve each patient’s unique challenge. Some recent examples:
“It’s almost a concierge service,” Brenisholtz said. “It provides a real help to people, but it is also a real convenience.”
Brenisholtz and Griffiths started their careers at retail pharmacies, where the environment made it challenging to have meaningful conversations with customers. In a retail setting, people tend to be in a hurry or are reluctant to ask questions out of courtesy to those waiting in line behind them.
“Here, they are genuinely engaged and invested in the information being passed back and forth,” Brenisholtz said. “The patient has the undivided attention of the pharmacist, and they are more comfortable asking questions than they are standing in line at a retail pharmacy.”
The team aims to pair patients with affordable medications and also looks to the future in order to keep them healthy, according to Dr. Shalz.
For example, the team helps patients find inhalers they will be able to afford over time, which helps prevent complications that require additional provider visits or hospitalization. And the bedside delivery program brings the education to the patient’s room, where they don’t have concerns about privacy and are free to spend more time explaining how to properly use the medication. It also makes it easier to solve problems.
For example, the team can use a special formulary app to determine which medication is covered by a particular patient’s insurance. Because the new approach takes additional time and resources, St. Luke’s is building the program slowly, starting with the Meridian team.
“It’s just a different level of care,” Brenisholtz said.
Chereen Langrill is a former communications coordinator for St. Luke’s Health System