Improving Medication Adherence with Point-of-Care Dispensing

An effective health care delivery system does not focus solely on the needs of patients under a physician's care. For treatment plans to work, patients must take their medications as prescribed. Patients who can follow their doctor’s instructions for at least 80 percent of their prescriptions are categorized as medically adherent.

However, according to the World Health Organization, nearly half of all patients do not meet these criteria. Patients often do not take their medications at the correct dosage or frequency. They also may stop a prescribed medication without consulting their physician.

The consequences of poor medication adherence can be fatal. Failure to take medicine as prescribed causes nearly one out of every three hospital admissions for people over 65, and more than 100,000 deaths a year are attributed to medication nonadherence. Some health organizations have ranked medication adherence as the primary issue impacting patient outcomes. To increase patient adherence, medical providers must understand the reasons that people do not take their medication.

The American Medical Association cites several behavioral reasons for patients engaging in medication nonadherence. Patients may be afraid of side effects or distrust their prescription due to negative media reports. Many people incorrectly assume that a lack of symptoms implies that they can stop taking their medicine. People who take multiple medications are also more likely to be nonadherent.

Moreover, patients may have difficulty ordering refills for multiple prescriptions, or they may not be able to travel to a pharmacy several times a month. Relatedly, a lack of communication between pharmacists and physicians can leave room for medical errors, drug interactions, and incorrect dosing.

Point-of-care dispensing, in which physicians fill their prescriptions in-house, is one approach that can help eliminate many of the justifications for medication nonadherence. States regulate point-of-care dispensing, and the practice is legal in 47 states. Requirements for in-office dispensing vary, but in most states, physicians must register to dispense controlled substances.

Physicians can design point-of-care dispensing systems in several ways. They may have white bag services, in which packaged medication is delivered to the practice and distributed to patients during their routine appointments. Other medical centers have pharmacies on site. Either way, patients leave their appointments with their medication in hand.

Physicians who can fill prescriptions are better equipped to prevent accidental interactions or overdoses, since they have direct access to their patients' medical histories. Further, patients can discuss topics such as side effects and other concerns during their appointments. Patients who feel informed about their treatment are more likely to be adherent.

In addition, point-of-care dispensing gives doctors far more control over their patients' dosage, and makes it easier to flag potentially dangerous interactions. It is also much easier for on-site pharmacists to communicate with physicians and patients.

Finally, many patients face obstacles to health care services, from advanced illness and mobility limitations to financial barriers, such as a lack of transportation. Point-of-care dispensing reduces the number of obstacles. Medical centers with in-office dispensing can also collaborate with insurance companies or pharmaceutical makers to reduce costs and pass on the savings to their patients.