Educate Before You Medicate : A Big Picture Look at Adherence Improvement

1. Educate Before You Medicate: A Big Picture Look at Adherence Improvement Ray Bullman Executive Vice President National Council on Patient Information and Education 7th Annual Patient Adherence & Engagement Summit Philadelphia, PA

2. About NCPIE • Multi-stakeholdermembership organization -- formed 1982 -- healthcare professionals, consumer & patient groups, industry, govt. agencies. One of the original patient safety coalitions. • Mission: Stimulate / improve communication of information on safe/appropriate medicine use to consumers &healthcare professionals • Convener, Catalyst, Clearinghouse of ideas & information to advance members’ shared mission. • “Medicine Education Team” – Patient is key player

3. Educate Before You Medicate: A Big Picture Look at Adherence Improvement • Develop an adherence game plan:Recommendations for action at the local, regional, and national level;   • Take a multi-stakeholder approach:The value of a collaborative national medication adherence awareness campaign; • Advance adherence at the point of prescribing and along the patient pathway: What’s new?  What’s driving change?

4. Develop an adherence game plan • Planets aligned; adherence is in the middle of the radar - The Age of Adherence • Big Picture approach  1 x 1 x 1 challenge • Systemic problem / systems-wide solutions • Everyone into the pool – Part D and Health Care Reform as drivers • Role for all / Responsibilities for all • Impacts are order of magnitude (Diabetes, Asthma, COPD, CVD, Cancer........) for pts., providers, pharma, payors • Prove It -- The Age of Evidence

5. Develop an adherence game plan • Enhancing Prescription Medicine Adherence: A National Action Plan(2007) • National awareness required (HBP model) • Increased emphasis on provider and student education & training • Multidisciplinary approach to adherence education and management • Address the barriers for patients with low health literacy • Increase funding / rigorous research agenda

6. Develop an adherence game plan • Enhancing Prescription Medicine Adherence: A National Action Plan • Create the means to share information about best practices in adherence education and management • Remove roadblocks for adherence assistance programs

7. Develop an adherence game plan • Other Action Plans / Other Action Pathways • NCL Collaborative National Awareness Campaign • NEHI Action Series • Call for care team demo projects • System-wide approach to improving medication adherence for chronic disease • Roundtable /Roundtable Highlights • Similar Commitments • Similar Goals • Similar Requirements (resources, research, evidence, systems-wide, patient inclusive)

8. Take a multi-stakeholder approach • Medicine Education Team– Patient is a key player (NCPIE approach); • Patient-Centered Primary Care Collaborative (PCPCC): • The Pt. Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes(Center believes that the ability to maximize the appropriate use of medications to prevent and control disease is critical to the success of the PCMH)

9. Take a multi-stakeholder approach • THE PATIENT AS A KEY PLAYER • Initiator (or not) • As different as night and day • What motivates you doesn’t motivate me (visa versa) • Lots of “stuff” going on; making medicine use relevant / important; • Reaching you (Blackberry/ Apps) may not work for your mom 

10. Advance adherence @ the point of prescribing & along the patient pathway • “Reintroducing the Oldest Advance in Medicine – TALKING”(NCPIE, 1989) • An assessment of the patient’s medication-related needs • Identification of the patient’s medication-related problems • Development of a care plan with individualized therapy goals and personalized interventions • Follow-up evaluation to determine actual patient outcomes (2010, PCPCC,The Pt. Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes

11. Advance adherence @ the point of prescribing & along the patient pathway • As in football, handoffs (care transitions) are important (Pre-prescribing; prescribing; post prescribing) • Empowerment begins /ends @t home; make notes/take notes before, during, after; other ears & eyes • Let’s Talk (Ask/Tell); motivational interviewing; putting adherence assessment tools/techniques to work; if you don’t know what to ask, you can’t ask; medicine list as a trigger; • Care teams -- comprised of both physicians and non-physician caregivers, including professionals such as community pharmacists who operate outside the physician practice (NEHI)

12. Advance adherence @ the point of prescribing & along the patient pathway • As in football, handoffs are important (Pre-prescribing; prescribing; post-prescribing) • Medication reconciliation – going in/inside/ going out (home); what about other team members (primary provider; neurologist, gastroenterologist, ophthalmologist, psychiatrist) • Home supports – written medicine information is undergoing a make-over (in quest for a single document solution); adherence packaging; refill reminders / alerts; help lines • Hi Tech – e-prescribing, PMR/EMR; online tools / supports; unlimited potentials / evidence?

13. Advance adherence @ the point of prescribing & along the patient pathway • As in football, handoffs are important (Pre-prescribing; prescribing; post-prescribing) • Prescriber / Patient Interface – (Adherence Red Zone) • Pharmacist / Patient Interface - (Adherence Red Zone) • Optimizing Healthcare Provider Supports • Optimizing Patient Supports – family members, other caregivers; aids, devices (all the Xs & Os on the board)

14. Educate Before You Medicate:A Big Picture Look at Adherence Improvement The Age of Adherence Opportunity October 19, 2010 - ?

15. Contact Information Ray Bullman, Executive Vice President bullman@ncpie.info National Council on Patient Information and Education (NCPIE) 200-A Monroe Street, Suite 212 Rockville, MD 20850 (301) 340-3940 - phone (301) 340-3944 - fax www.talkaboutrx.org www.bemedwise.org www.mustforseniors.org www.learnaboutrxsafety.org