A spoonful of sugar makes the medicine go down in Mary Poppins, but in real life, it’s much more complicated than that.
Two-thirds of patients do not take their medications as prescribed and patients with chronic illnesses have the lowest adherence rates, according to www.adhereforhealth.org. This becomes even more challenging in rural South Dakota where two-thirds of the counties have a health-care professional shortage and the nearest pharmacy might be an hour’s drive away.
To address these challenges, SDSU pharmacy practice faculty are partnering with the South Dakota Department of Health, which received a new five-year funding opportunity through the Centers for Disease Control and Prevention.
“At the end of the day, no matter how good a doctor is and how accurate the diagnosis … if a patient does not take the medication, it’s not going to work,” said Sharrel Pinto, the Hoch Family Endowed Professor for Community Pharmacy Practice, who leads the SDSU team. “We want to build community-based programs statewide that help improve medication adherence and patient outcomes.”
Pinto and assistant professors Chamika Hawkins-Taylor and Alex Middendorf will work with the South Dakota Heart Disease and Stroke Prevention Program and the Diabetes Prevention and Control Program. The researchers developed a five-year action plan that the SD DOH plans to fund annually through the CDC funding opportunity. For the first year, Pinto received $500,000 for her work.
“SD DOH has the ability and desire to help the community—and now with this CDC project, we have the resources that will really make a difference in the next few years,” said Pinto, who hopes to add more SDSU researchers to the project.
More than 50,000 South Dakotans have heart disease or have had a heart attack, while 17,000 have experienced a stroke according to the South Dakota Department of Health, Behavior Risk Factor Surveillance Survey 2017. More than 72,000 South Dakotans have diabetes, according to the South Dakota Diabetes State Plan 2018-2020.
The CDC chronic disease cost calculator estimates that cardiovascular diseases—heart disease, stroke and high blood pressure—cost South Dakotans $981 million in 2010. The cost estimate for diabetes was $339 million. Improving medication adherence statewide can help reduce health care costs and improve patients’ quality of life.
Expanding pharmacist role
“Pharmacists play a large role in relation to managing heart disease and diabetes,” said Rachel Sehr, Heart Disease and Stroke Prevention coordinator for SD DOH. Patients may see their doctors up to several times a year but typically have monthly contact with their pharmacists. “They have more opportunities to go through the education piece, more frequent touch points. That person can help pull the patient’s entire care team together.”
Pharmacists, who are ranked as one of the top trusted professionals, are in a unique position to make a difference, Pinto explained. Patients have greater access to their pharmacists and tend to have longer conversations with them.
“We want to expand patient care beyond just dispensing medications. Medication therapy management is a mechanism through which pharmacists can counsel patients on their medications, their disease and the therapy,” Pinto said. Some patients, for instance, stop taking their medications because of side effects.
“Many times, the solution is very simple,” she stated. For example, metformin, a common diabetes medication, must be taken with food to prevent gastrointestinal problems, but many patients may not know that and consequently stop taking their medication after they experience a side effect.
The goal is to develop a statewide model that uses different types of programs and services to help South Dakotans more effectively manage and prevent diabetes, heart disease and strokes and have a better quality of life.
Mapping patient landscape
During the first year of the grant, the researchers will conduct interviews and focus groups with patients, providers and the insurance companies, Pinto explained. Providers can include doctors, nurses, pharmacists, dieticians, extension coordinators, diabetes educators and community health professionals.
“We are asking what challenges they face and building a program that meets patients’ needs, while also taking into account the payers. This is a unique approach to program building and population health management,” Pinto said.
“Most of the time patients are doing everything possible to live a good quality of life but there are so many hoops to jump through,” she continued. Patients with multiple chronic conditions may be juggling anywhere from three to six medications.
“We want to map the patient’s journey, what happens in their treatment life span to understand what the landscape looks like,” Pinto said. “We want to look at the harsh realities of day-to-day living with these conditions and how we can come up with solutions that are informed and guided to help overcome barriers.”
Each year 20 to 25 pharmacy students will be involved in the project. “The students will be getting hands-on training in something that is innovative and creative,” she said. “As they graduate, they will take this meaningful, impactful information with them and shape their own communities.”
The second year, the researchers will use community resources to develop programs to help fill identified gaps. Programs will be implemented in the third year. In the fourth and fifth years, the researchers will evaluate successes, failures and lessons learned to determine how they can further improve the programs.
“The five-year project gives us the time and the resources to bring care to the people who need it the most,” Pinto said. “At the end of the day, we want to be able to say the programs we have created are sustainable and help improve the quality of life of our patients.”
Sehr agreed, “When we accomplish this, it will drastically affect the way these patients receive care throughout the state.”