Pharmacist Counseling to Improve Inadequate Medication Adherence in Parkinson’s Patients
You’ve heard it before—pharmacists can improve adherence by reaching out to patients—but it’s crucial to bring it up again because inadequate medication adherence in Parkinson’s patients leads to a cycle of worsening outcomes. After developing a protocol, counseling won’t take a lot of your time, yet the benefits are immeasurable. Pharmacists who intervene can touch a substantial number of people with Parkinson’s, helping them achieve better symptom management and the chance to enjoy daily life, while saving health care costs and avoiding hospitalization.
Impact of Pharmacist Counseling and Reimbursement for MTM
One way to grasp the impact you can have in the local community is to look at your sales for levodopa and other Parkinson’s medications, then stop to consider that as many as 73 percent of those patients don’t adhere to their treatment plan.1 The following information further illustrates the extent of the problem and the challenges faced by patients with Parkinson’s disease:
- About 1 million people in the United States have Parkinson’s—60,000 new cases diagnosed annually.2
- Parkinson’s is the 2nd most common neurodegenerative disease.
- Parkinson’s is the 14th leading cause of death.
- Non-motor symptoms such as depression, sleep disorders, and cognitive impairment are often more debilitating than motor symptoms.
- Drug-induced psychosis occurs within four years in 60 percent of patients.
- Levodopa increases the risk of hypotension and raises levels of homocysteine, which is associated with a higher chance of cardiovascular disease.
Since Parkinson’s is related to age—the average age of onset is 60 years—most patients have a higher risk for other chronic health conditions and they probably take multiple medications. They’re also covered by Medicare, so if they meet the criteria for Medication Therapy Management (MTM) you could get reimbursed for time spent educating about medications and encouraging adherence.
Three criteria for MTM:3
- Part D enrollees must have multiple chronic diseases:
- Sponsors may set the minimum at two or three diseases.
- Sponsors may choose to allow any condition or target specific diseases—diabetes, chronic heart failure, dyslipidemia, and hypertension were the top targeted diseases in 2016, followed by COPD, asthma, osteoporosis and depression.
- If patients must have specific targeted disease, sponsors provide a list of at least five of the top chronic conditions and patients can have any combination of diseases.
- Patients must take multiple Part D drugs—a little more than half of MTM programs require patients to have filled at least eight covered Part D drugs, but requirements vary.
- Patients should be likely to incur $3,507 for covered Part D drugs.
Once patients are approved for MTM, they must receive an annual comprehensive medication review and quarterly targeted medication reviews with follow-up interventions as necessary. You have some leeway as interventions may be done by pharmacy interns and consultations can be person-to-person, interactive or via telehealth.
Counseling Tips to Improve Medication Adherence in Parkinson’s Patients
At the low end, an estimated one-third of Parkinson’s patients fail to adhere to the medication regimen. On the high side, studies report an astounding 73 percent are nonadherent. Reasons for such low adherence are complex—they may include personal factors, financial issues, poor doctor-patient communication, cultural beliefs, or lack of a support system. But medication is the only hope Parkinson’s patients have for ameliorating symptoms, so pharmacists need to be vigilant about medication management and counseling to improve adherence. Try to include the following components in patient counseling sessions:
Teach about the medication and adverse effects: Pharmacists routinely give this type of advice but take it a step beyond the usual for patients with Parkinson’s—the more they know, the more likely they are to follow prescription instructions.
- Motivate – Patients may be motivated to know that the introduction of levodopa cut the death rate in half and extended longevity. In other words, emphasize what medications mean for their long-term outlook.
- Educate about adverse effects – This boosts compliance because patients know what to expect. Explain that most side effects, like nausea, can be treated. Tell them to call their doctor before they stop taking medications.
Set-up reminders and memory aids: The need to take multiple doses of medication—and simply forgetting a dose—are some of the most common reasons for nonadherence. Patients who qualify may solve the problem with controlled-release levodopa. Otherwise, figure out a reminder system that they’ll actually use. If they’re avid tech users, suggest they use a smartphone app for medication adherence, set up text message reminders using a short message service, or schedule automatic recurring email reminders (with an app like Gmail’s Boomerang). Some patients may respond better to techniques like blister packs, a pill box or even a calendar where they can put a check every time they take their medications.
Assess motor and nonmotor symptoms: Depression makes Parkinson’s patients three times more likely to have poor medication adherence, but other nonmotor symptoms such as sleep disorders, psychosis, and cognitive impairment also have a significant impact.4 Be prepared to assess for nonmotor and motor symptoms—when they persist or worsen, it’s essential to protect patient safety by referring them to the doctor.
Educate about Parkinson’s: Poor knowledge about the disease is a predictor for nonadherence. Patients should understand why they need medication and the consequences of not sticking with the regimen. The Parkinson’s Disease Foundation has a long list of printable fact sheets covering all aspects of the disease.5
Include caretakers in counseling: Caretakers are strong allies for medication adherence. They can put up reminder notes, dispense the medication throughout the day, or check the pill box to be sure each dose was taken.
Pharmacist Intervention is Highly Successful at Promoting Adherence
In a report on patient adherence, the management consulting firm, Capgemini, said that pharmacist programs are one of the most successful interventions, yet they’re seldom implemented.6 It may take more time at the start if you want to enroll in an MTM program and set up protocols, but over time, the actual counseling can be worked into your schedule. As you help boost medication adherence in Parkinson’s patients, you’ll also improve medication compliance across all their chronic diseases. In the process, your efforts can extend longevity and improve quality of life.
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- “Key Cogs in the Management of Parkinson’s Disease,” December 2016, http://drugtopics.modernmedicine.com/sites/default/files/images/DrugTopics/UCONN/drtp1216_CE.pdf ↩
- “Statistics on Parkinson’s,” accessed January 2017, http://www.pdf.org/en/parkinson_statistics ↩
- “2016 Medicare Part D Medication Therapy Management (MTM) Programs,” 2016, https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/CY2016-MTM-Fact-Sheet.pdf ↩
- “Parkinson Medication Adherence is Suboptimal,” February 2015, http://www.neurologytimes.com/parkinson-disease/parkinson-medication-adherence-suboptimal ↩
- “Parkinson’s Fact Sheets,” accessed January 2017, http://www.pdf.org/en/factsheets ↩
- “Patient Adherence: The Next Frontier in Patient Care,” accessed January 2017, https://www.capgemini.com/resource-file-access/resource/pdf/Patient_Adherence__The_Next_Frontier_in_Patient_Care.pdf ↩