How Health-System Pharmacists Can Improve Adherence in ACS Patients

JUNE 13, 2016
Meghan Ross, Senior Associate Editor
Jane Doe experiences acute coronary syndrome (ACS), heads to the hospital, and is faced with a barrage of new medical terms she’s never heard of, explanations about the ACS event from physicians, medications and instructions from the pharmacist.

She may leave the hospital with 4 or 5 new medications and may not fully understand how to use them or what their purpose is. That’s where pharmacists can step in to be proactive about her adherence and to manage her health literacy.

Christopher Betz, PharmD, BCPS, FKSHP, FASHP, a professor at Sullivan University College of Pharmacy, told that some of the ways pharmacists can use motivational interviewing to improve adherence in ACS patients.

“Adherence is key with outcomes of acute coronary syndrome,” Dr. Betz said, whether it’s dual antiplatelet therapy, statins, or beta-blockers. “If they’re not adhering to it, we’re going to have another event.”

Dr. Betz uses the OARS technique to ensure patients understand and follow their medication regimen:

“O” stands for open-ended questions.
They can help form a partnership between the pharmacist and patient during motivational interviewing. Dr. Betz suggested that giving patients time to explain what they’re thinking can also help the pharmacist gauge their ability to be adherent.

“A” stands for affirmation.
“It’s so much easier to have someone change their behavior if you tell them what they’re doing well first,” Dr. Betz said. “No one likes to be told what they’re doing is wrong.”

He suggested starting the conversation off by listing what the patient is doing correctly, then focusing on where he or she can make improvements.

“R” stands for reflective listening.
This is where pharmacists’ empathy comes in. Through reflective listening, pharmacists can better understand what issues the patient is concerned about, and they can also build a stronger connection. One way to show reflective listening is to use a phrase like, “It sounds like X is happening, which I understand can be frustrating. Do I have that right?”
“S” stands for summary.

Dr. Betz pointed out that this can also work as a teach-back strategy to make sure patients understand what they’re supposed to be doing with their new treatments and to measure their buy-in to the medication regimen.

“If they say they can’t do it, changes can be made before they’re discharged,” he said.