The pandemic has disrupted many of our daily processes and routines, which means many people's adherence to their medication regimens may be thrown off.
Here, six pharmacy leaders discuss how the pandemic has affected medication adherence and what their health systems are doing to make sure their patients can stay healthy.
Editor's note: Responses have been lightly edited for clarity and length.
Gary Kerr, PharmD, chief pharmacy officer at Baystate Health (Springfield, Mass.): Despite a few hiccups in the March time period when the pandemic first was gaining momentum in western Massachusetts, our retail and specialty pharmacies immediately developed and implemented operational strategies to promote safety and medication adherence. Internal physical changes such as distancing signs, spacing marks on floors, masking and Plexiglas cash register barriers relieved some anxieties about walking into the pharmacy.
Of equal or more importance, we also created curbside delivery capabilities and expanded our home Rx delivery program. This is done in part to allow chronically (or acutely) ill patients to minimize their need to leave their homes to go to public places, and it also promotes medication adherence when many patients were believed to be "stopping their medications" and waiting for the pandemic to die down. Finally, our pharmacy staff ramped up the commitment to outreach calls and supplemental adherence calls in a concerted effort to perform a telephone wellness/assessment exercise. Once we move into late 2020, we expect our adherence metrics to positively reflect this body of work.
Terri Wank, chief of pharmacy at Albany (N.Y.) Stratton VA Medical Center: Our experience at the Albany Stratton VA may not represent that of the general public when it comes to patient access to medications and medication information from clinical pharmacists. Our veterans can stay at home and continue to have access to their providers and clinical pharmacists through VA Video Connect. Veterans can sign in to an appointment from their computer or cellphone and communicate effectively with their VA providers.
The VA pharmacy continues to provide prescriptions through the mail to be delivered to the veterans' doorstep or post office box. Due to the patient-centric processes VA has in place, we have not seen a drop in prescription processing during the pandemic, and VA pharmacists are continuing to see good medication adherence from veterans.
Matthew Pond, PharmD, vice president of pharmacy services at HonorHealth (Scottsdale, Ariz.): We are seeing changes to people having insurance coverage, where 27 million Americans have lost health insurance during the pandemic. That directly impacts patients with conditions requiring medication therapy, and we expect to see these trends continue as increasing barriers to care of outpatient medication adherence.
The second element is not only coverage, but the ability to pay out of pocket. With the national unemployment rate exceeding 11 percent and the loss of health insurance, that is a dangerous combination for medication adherence.
Geri Buderwitz, senior manager of pharmacy strategy and business development, Boston Medical Center: At Boston Medical Center Health System, we predicted the pandemic to be a significant potential barrier to medication adherence. In order to keep our high-risk patients safe by mitigating the need to leave their homes, we launched an initiative in mid-March to shift patients to our mail-order pharmacy.
This allowed us to continue to provide medication delivery services to our most vulnerable populations who were either at risk of skipping their next refill due to fear of visiting the pharmacy or who were at highest risk of contracting COVID-19. Through targeted outreach via live and automated calls, email campaigns and direct partnership with providers, we successfully shifted over 1,800 patients within four months.
Richard Demers, chief administrative officer of ambulatory pharmacy services at Penn Medicine (Philadelphia): Anecdotally, I have the following observations:
We were able to support some folks early on who had difficulty getting hydroxychloroquine for their lupus condition, and I'm thinking that there may be those that we were not aware of. Certainly these folks received no support from their chain pharmacies, as they were calling on their own. Our pharmacists also counseled a number of patients on immune compromising agents that were wary of continuing during the pandemic. Again, I'm thinking some patients may have done this outside of our system.
Ambulatory infusions decreased as some patients were fearful of the infusion center. We also received requests from patients supported by commercial pharmacies that were delayed, in short supply of other drugs or were closing due to lack of staff. The destruction of over 100 pharmacies regionally also did not help patients stay compliant. We did see an influx from this.
Overall, I think these are the challenges I am aware of. We were able to have our patients maintain the same adherence rates due to our interactive structure.
Cindy Williams, vice president and chief pharmacy officer at Riverside Health System (Newport News, Va.): Here's a personal example, as I manage medications for my parents, who are in independent living but need some support. Due to the change in their routines related to COVID (e.g. not going to meals in the facility dining room), medication adherence has been impacted. My parents used their routine of going to the dining room for meals to guide medication administration since medications are timed with breakfast, lunch and dinner. With the restrictions of no communal dining, meals are being brought to the room and are often not consistent in timing. This has impacted my father's insulin administration and blood glucose control primarily, since I facilitate compliance packaging/medication boxes for the oral medications.