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Rx Adherence2013
Strategies to Improve Patient Outcomes
Healthcare Compliance Packaging Council
Developing a Collaborative, Multi-stakeholder
Adherence Action Agenda
The NCPIE A3 Project
Ray Bullman
NCPIE Executive Vice President
Florham Park, NJ
March 12, 2013
Avoiding Yet Another
Déjà Vu All Over Again
Nearly 20 years ago NCPIE published “Prescription
Medicine Compliance: A Review of the Baseline of
Knowledge.” This 1995 report included a series of
recommendations to improve adherence for:
Physicians and Medical Schools
Pharmacists, Pharmacy-Providers and Educators
Pharmaceutical Manufacturers
All Health Professionals
Managed Care Organizations and Hospitals
Nurses and Educators
Avoiding Yet Another
Déjà Vu All Over Again
Enhancing Prescription Medicine
Adherence: A National Action Plan
NCPIE 2007 Report - essentially a mirror image
of 1995 report findings.
Medication nonadherence: a major public
problem with profound health and economic
The A3 Project – why re-visit adherence
• Defines what NCPIE is about – stimulate and improve
communication to promote safe & appropriate medicine
use to consumers and Healthcare Professionals
• Reset the Compass – It’s a very different world than it
was 5 years ago.
• Logical role for NCPIE to play (3 “Cs” )
Fulfilling the 3 “Cs”
Collaborator .....
Long, Winding Road
Priorities and Approaches for Improving Prescription
Medicine Use By Older Americans
Children & America's Other Drug Problem: Guidelines for
Improving Prescription Medicine Use Among Children and
Prescription Medicine Compliance: A Review of the
Baseline of Knowledge
Enhancing Prescription Medicine Adherence: A National
Action Plan
Ascertaining Barriers for Compliance Project – European
Adherence Action Agenda – NCPIE A3 Project
If Not Now – When?
• Awareness, action and demonstration of impact
has never been greater – Seize the day...
• Tech applications (operational and potential) are
at an all time high  and increasing
• Alignment of the stars (and incentives)
National Plan of Action
to Advance Medication Adherence
In August 2007, NCPIE released “Enhancing
Prescription Medicine Adherence: A National Action
Plan,” a renewed nationwide call to action for improving
medication adherence through patient information and
education, health professional intervention, expanded
research, and supportive government policies.
Report included a suggested 10-step plan of action for
diverse stakeholders’ consideration.
Source: “Enhancing Prescription Medicine Adherence: A National Action Plan” (NCPIE, August 2007;
Recommendations for Action
Elevate patient adherence as a critical health care
Agree on a common adherence terminology that will
unite all stakeholders.
Create a public/private partnership to mount a
unified national education campaign to make patient
adherence a national health priority.
Establish a multidisciplinary approach to adherence
education and management.
Recommendations for Action
Implement professional training and increase the
funding for professional education on patient
medication adherence.
Address the barriers to patient adherence for
patients with low health literacy.
Create the means to share information about best
practices in adherence education and management.
Recommendations for Action
Develop a curriculum on medication adherence for
use in medical schools and allied health care
Seek regulatory changes to remove roadblocks for
adherence assistance programs.
10. Increase the federal budget and stimulate rigorous
research on medication adherence.
The A3 Developmental Process
• NCPIE surveyed cadre of key stakeholders to
determine / validate A3 focus areas
• NCPIE engaged a facilitator to direct
stakeholder discussion / decision-making
process / consensus development during two
project advisory team meetings
• NCPIE mission aligns with focus on adherence
Alignment of NCPIE’s Mission
with these Focus Areas
• Chronic conditions & co-morbidities:
where we know taking meds safely and
appropriately will make a difference in
• Patient-related factors;
• Provider-related factors.
Over-Arching Macro Factors
• Macro factors: current drivers impacting or reshaping
medical care configuration, access, delivery, payment:
Practice patterns and configurations
Policy change efforts
Payment / Incentives
Pharma innovation
Packaging innovation
Technology innovations & adoption
Health Literacy
The game of life – evidenced by the patients’
continuum of care (the journey)
A3 Structure
High priority – individuals with multiple chronic conditions;
Top dyads and top triads for co-morbid chronic conditions
An across the continuum perspective: adherence improvement for one
chronic condition very different than for multiple chronic conditions; very
different when multiple providers are involved;
A Patients’ Medicine Journey: Many similarities / Many differences
Older adults with multiple chronic conditions
Unrelated caregivers for older adults
Aging boomers with caregiving responsibility for aging parents;
Working age adults (who also manage meds in the home);
A Window into High-need Patients
• Can tell a sweeping, compelling story with this
• Spotlights environmental challenges for
vulnerable populations: living alone;
transportation needs, access to providers;
physical deficits (hearing, vision)
• Addresses a wide range of patient, provider and
systems factors
A Window into High-need Patients
• Patient Factors (does patient or caregiver have):
– Low health literacy?
– Misunderstanding or need for educational
– Economic challenge, esp. inability to pay for needed
– Cultural beliefs that might affect adherence?
– Depression or other behavioral changes
– Transportation or other challenges to accessing medrelated services?
(There and Home Again, 5 Responsibilities of Ambulatory Practices in High Quality Care Transitions, AMA Making Strides in Safety
To the Tune of “Go in and Out the
… as you have done before **”
• Adverse events – including nonadherence at the
core of hospital readmission problem.
• Drugs involved in 88% of emergency hospital
admissions caused by ADEs of older adults:
– hematologic,
– endocrine,
– cardiovascular,
– CNS,
– anti-infective agents.*
* Budnitz, DS et al, N Engl J Med 2011;365:2002-12
** Pete Seeger, Folksinger
The stakes have never been higher
• 2/3rds of the hospitalizations due to
unintentional drug overdoses
• Just 4 types of meds -- warfarin, insulins, oral
antiplatelet agents and oral hypoglycemic
agents – together accounted for 7 in 10 of the
emergency hospitalizations.
The A3 Project -- Spotlight on:
• Patient – & provider-related adherence factors
• Chronic & co-morbid conditions
• Interplay of macro-factors
• Adherence research – in development, planned; pilots,
demos, best practices
• Advocacy – what is not happening? how can we make
it happen?
• Real-time A3 Portal
The A3 Project
Collaborative in design (ground up)
Inclusive – who is committed to change;
contribution to adherence improvement.
Supportive – who can help advance
change and improvement?
Comprehensive – key stakeholder
perspectives & input
Contact Information
Ray Bullman
Executive Vice President
National Council on Patient
Information and Education (NCPIE)
200-A Monroe Street, Suite 212
Rockville, MD 20850
(301) 340-3940 - phone
[email protected] – email
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