Medication adherence communications in community pharmacies: A naturalistic investigation

• Medication non-adherence went undetected in the majority of the interactions.
• Low rates of being asked if there were questions when picking up medications.
• Majority reported directions of use as only topic for new medication consultation.
• Most pharmacists did not probe if individuals reported a medication was ineffective.
• Low pharmacist and insurance plan engagement in suspected medication non-adherence.

ObjectiveTo describe the extent of pharmacy detection and monitoring of medication non-adherence, and solutions offered to improve adherence.MethodsParticipants were 60 residents of the Boston area who had a generic chronic medication with 30 day supplies from their usual pharmacy. Participants received a duplicate prescription which they filled at a different pharmacy. For 5 months, participants alternated between the two pharmacies, creating gaps in their refill records at both pharmacies but no gaps in their medication adherence. Participants followed a scripted protocol and after each pharmacy visit reported their own and the pharmacy staff’s behavior.ResultsAcross 78 unique community pharmacies and 260 pharmacy visits, pharmacies were inconsistent and inadequate in asking if participants had questions, discussing the importance of adherence, providing adequate consultations with new medication, and detecting and intervening on non-adherence. Insurers rarely contacted the participants about adherence concerns.ConclusionThere is a need for more structured intervention systems to ensure pharmacists are consistently and adequately educating patients and detecting/managing potential medication non-adherence.Practice ImplicationsThe present study calls for more attention to building infrastructure in pharmacy practice that helps pharmacists more consistently identify, monitor, and intervene on medication adherence.