Open Forum

Greetings fellow outpatient nurses,

I work in the Managed Care department of our organization. As part of a mutual effort with one of our Medicare Advantage partners (Florida Wellcare), I'm involved in a medication adherence project. The goal is to improve our quality scores for our MA patients by assisting them to keep in compliance with certain medications for diabetes, CAD, and HTN. Working solo, I've emphasized first making sure our Wellcare patients have a current prescription for the medication of concern (assuming they are actually on it), and then making efforts to reach out to those patients in danger of "falling off the back"; that is, being out of compliance by either not getting their prescriptions or by missing multiple doses. A big part of my outreach has been in using our patient portal (MyChart in Epic) for compliance-related messaging. I have found out that, unfortunately, over half of those messages go unread, though they are helpful for some. More recently I've found the time to start calling patients directly, which allows me to get in touch with people who either don't read their patient portal messages or don't have access to MyChart.

After some leadership turnover, I finally have an opportunity to improve our process. I'll be doing a presentation after the holidays that will describe my current efforts in that regard, and also advocate for some best practices for improvement. Medical assistants can pend orders to providers and also make patient outreach phone calls, so that will be part of my recommendations-to have an MA to work with. In addition, I'll do a diligent literature review beforehand to see what kind of best practices might be recommended.

Do you folks have any recommendations, either of relevant articles or best practices that you use?

Best Regards, DC

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David Cox RN BSN
U.F Health Jacksonville
Jacksonville FL
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Thank you for the work you are doing, David.

So much of what exists regarding the process of medication reconciliation focuses on the inpatient setting. The AMA Steps Forward content includes a module/toolkit on Medication Adherence. The video 'We Didn't Ask, They Didn't Tell' helps practice team members understand why patients may or may not take their meds as prescribed.  https://edhub.ama-assn.org/steps-forward/module/2702595.

A pharmacist colleague recently related to me one of her patient counseling encounters for a man who requested a refill on his atorvastatin too early. He explained to her that when he eats extra pizza he takes an extra dose or two for his cholesterol. So important to get to the root cause!

A relative's hypertension specialist wrote one of his Rx's to allow for two doses daily in the event he needed to titrate up based on his BP readings. His BP was well-controlled, so he remained on once daily. His Humana MA plan messaged and texted him repeatedly since he was not taking his medicine 'as prescribed'. He was labeled as non-adherent, when in fact he was not. 

This is such a complex issue!

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Leslie McDowell ANP-BC DNP RN
Northwest AHEC/Wake Forest Univ Sch of Med
Winston Salem NC
(336) 972-7852
ANP-BC DNP RN
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Hi Olivia,

Yes, it's a complex issue, reminding me of the population health adage, you can't help everybody, but it's still worthwhile to make an effort because, when you do, you will help some. The helpful link sent by another poster in this space was to research done based on inpatient hospital discharge. Therefore it doesn't address the particulars of outpatient primary care, though the core concept is of course valid. Med rec has become a big issue for our third party payor partners, for good reasons. Perhaps that's the best place to identify challenges in compliance, in the PCP office visit--certainly during the Medicare AWV or any other wellness-related visit. In some of my compliance-related phone calls to patients, I am able to identify a barrier, but of course I can't make anybody get their hands on that next refill. 

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David Cox RN BSN
U.F Health Jacksonville
Jacksonville FL
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Original Message:
Sent: 12-17-2024 09:38
From: Leslie McDowell
Subject: Medication Adherence

Thank you for the work you are doing, David.

So much of what exists regarding the process of medication reconciliation focuses on the inpatient setting. The AMA Steps Forward content includes a module/toolkit on Medication Adherence. The video 'We Didn't Ask, They Didn't Tell' helps practice team members understand why patients may or may not take their meds as prescribed.  https://edhub.ama-assn.org/steps-forward/module/2702595.

A pharmacist colleague recently related to me one of her patient counseling encounters for a man who requested a refill on his atorvastatin too early. He explained to her that when he eats extra pizza he takes an extra dose or two for his cholesterol. So important to get to the root cause!

A relative's hypertension specialist wrote one of his Rx's to allow for two doses daily in the event he needed to titrate up based on his BP readings. His BP was well-controlled, so he remained on once daily. His Humana MA plan messaged and texted him repeatedly since he was not taking his medicine 'as prescribed'. He was labeled as non-adherent, when in fact he was not. 

This is such a complex issue!

------------------------------
Leslie McDowell ANP-BC DNP RN
Northwest AHEC/Wake Forest Univ Sch of Med
Winston Salem NC
(336) 972-7852
ANP-BC DNP RN
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