Bill G. Felkey

Medication adherence and persistence : A comprehensive review

Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients’ understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients’ readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors—such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects—are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient’s needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.

Adherence Screening and Monitoring

Patient adherence is an essential goal of pharmaceutical care and can be an initial focus for cognitive services in a traditional pharmacy. Pharmacists are well placed to manage adherence programs. Activities associated with adherence include screening or assessment, follow-up monitoring, and use of memory aids or refill reminders. Technology is available in many forms to assist pharmacists in this role. The pharmacists role in adherence should focus on achieving desirable patient outcomes. Services associated with adherence programs need not be attached to distribution activities. Producing cost-effective drug therapy outcomes will continue to be of critical value to patients, health care systems, and third party providers.

Potential uses of google glass in the pharmacy.

Technology companies are in a constant battle for consumers’ interest in their products. This leads to rapid change and innovation. Google Glass is a recent innovation that will soon be available to the general public. In this article, we briefly describe our experiences with Google Glass and suggest ways we think it can be used in the hospital pharmacy setting.

Automated Intravenous Preparation : Robots for the Pharmacy

This month we address an emerging technology that we believe will one day be as common as automated dispensing cabinets. Automated, robotic intravenous preparation is not as new to the area of pharmacy as many may think. Recently, United States Pharmacopeia <797> regulations prompted serious consideration and evaluation of this technology by many pharmacy departments. This article provides an overview of the vendors, their products, and other considerations for your due diligence.

Comparison and Analysis of the National Drug Code Systems among Drug Information Databases

National Drug Codes (NDC) is a drug identification code that is widely used to identify each unique commercially available drug product in the computerized health care industry. Various NDC database systems are currently used for the drug claims process, inventory control, and drug utilization review in the industry. Using a relational database, comparison and analysis were performed among eight major NDC database sources from the Food and Drug Administration, the Health Care Financing Administration, Medicaid, Redbook®, Medi-Span®, First DataBank®, Bergen Brunswig-Durr Fillauer®, and the Department of Veteran Affairs pharmaceutical information systems. A large discrepancy of comparability among those major NDC database sources was found with the percentage of matched rates ranging from 29.8–99.3%. The study suggests that a public central repository of a completed NDC database system is needed as a standard NDC reference for the health care industry in order to improve the comparability, accessibility, and quality of drug information.

Implementing PDA Initiatives in Health System Pharmacies

Launching a departmental-level PDA initiative requires careful planning if it is to meet with success. This months column describes how health system pharmacy managers can develop effective PDA adoption strategies.

Data mining for the health system pharmacist

Data mining is an application of computer technology that allows pharmacists to analyze the large amounts of clinical and administrative data related to patient care that health care organizations accumulate. Data mining is the process of taking the raw material (data) from the data warehouse and converting it to information that can be used by decision makers. Online analytical processing (OLAP) is the tool that accomplishes the data mining process. This article introduces the concept of data mining and related technologies, including the data warehouse, data mart, and OLAP — concepts that are closely related to one another. The benefits of applying data mining to pharmacy practice, with a focus on the point of care, are discussed. Successful data mining often requires an enterprise-wide information system as a prerequisite. Data can then be collected electronically at all points in the health care supply chain. A strategic view of the information flow in an acute care setting is provided. To further illustrate the application of data mining, several examples of OLAP integration are given. In addition, some unique data sources and a pharmacy specific reporting technology are described.

Engaging Patients with Digital Tools: What We Think We Know:

Patients who are engaged in their own care have better outcomes and cost the health care system less money. Creating the environment that supports patient engagement has been a recent focus across the United States, and digital tools have been suggested as an important piece of patient engagement. We discuss what we think we know about digital engagement, and present data of what is actually occurring.

An Optimistic but Cautionary Outlook on Mobile Health

Mobile health (mHealth) pushes forward and provides an active area for research. We briefly review 2 mHealth research articles and discuss the implications of their findings for hospital pharmacists.

Palm OS or pocket PC

This continuing series will be a valuable resource for both experienced and novice users of handheld computer technology. Topics will include how to evaluate hardware and software, clinical and business applications, and the development of a “digital peripheral brain.” The authors will also discuss PDA organization skills that can maximize professional and personal efficiency.