1. You can’t take what you don’t have: A multidisciplinary quality improvement project to increase
medication adherence rates in a diverse teaching health center
Katherine Wiegert, MD, MPH1,2 Daniel White, MD1,2 Jennifer Feng, MD1,2 Allison Edwards, MD1,2 Ron Kapioski, PharmD1 Jessica Bull, MD1 Thomas J. Staff, MD, MPH1,2
1 Denver Health Medical Center, 2 University of Colorado Family Medicine Residency Program
Background
Process
Results
Conclusions
Lowry Family Health Center is a Federally Qualified Health Center that cares for patients born in 121 different countries who speak 52 different languages. Lowry houses a medical clinic with over 26,000 visits annually, co-located behavioral health providers, the Denver Health Refugee Clinic, a dental clinic, a pharmacy, and a WIC site. Focus groups were conducted in our most common non-English, non-Spanish languages in and identified, among other concerns, a general dissatisfaction with obtaining and understanding the medication pickup, refill, and administration process.
Process mapping occurred by working with providers, RNs, MAs, pharmacy staff, patient navigators, social workers, and patients via in-person meetings and telephone interviews to identify potential interventions.
There were modest decreases in the rate at which medications were sent back to central pharmacy. Additionally, there was a subjective improvement in patient navigation through clinic based on interviews with clinic staff
Due to these successes, the intervention is still used in clinic. Furthermore, modifications to the orange sheet were made with feedback from pharmacy and other staff members.
Provider writes a NEW prescription at a visit
Patient receives the med within 10 days at the Lowry Pharmacy ?
Next Steps
21%
There were 266 medications from 204 patients returned to stock in the pre-intervention period versus 308 medications from 200 patients in the post-intervention period.
Although there was an overall increase in unclaimed medications, there was an 8% reduction in the proportion of unclaimed medications from same-day prescriptions (61.3 versus 53.4%, P=.03).
Excluding over-the-counter medications, there was a 12% reduction in this proportion (64.6 versus 53.1%, P=.046).
To keep or not to keep?
To modify or not to modify?
Notably, patients did not know that they needed to check in with the pharmacy to get their medications filled when a receiving a medication prescribed during a visit, leading to hours-long waits for some patients.
21%
Purpose & Objectives
Medication non-adherence is a significant and complex medical issue.
62.7% of doctors visits involve drug therapy with 48.7% of Americans taking at least one medication every day; however, according to the CDC, approximately 20-30% of prescriptions are never filled. §
The objectives of this quality improvement project were two-fold: First, to determine why patients do not pick up medications. Secondly, to identify and implement simple, low-cost interventions to increase the rate at which prescribed medications were picked up from our clinic-based pharmacy.
Though we accomplished much during this short PDSA cycle, there are many future directions we can go from here:
Tailor interventions to clinic population
Address other communication barriers in medication adherence
Formal post-intervention interviews with patients and clinic staff
Lengthen the post-intervention period
Explore how Denver Health’s Financial Aid Programs
affects patient adherence
Multilingual clinic & pharmacy orientation videos
Quick references in multiple languages for meds
available OTC
% of Returned Medications Prescribed Same-Day
Prescriptions Written at Lowry
Approximately 15% of prescriptions sent to the clinic’s pharmacy are unclaimed.
Of the unclaimed prescriptions, 61% were prescribed on the same day as a doctor’s visit.
For our intervention, patients were given a bright orange slip that matched a check-in sign at the clinic pharmacy. The slip denoted the patient, ordering provider and the patient’s language.
PHARMACY
THE PHARMACIST IS IN
Patients were instructed to take the slip to the matching sign at the pharmacy to obtain their medications. This intervention was presented at clinic meetings to enlist help from all providers, staff and employees to help maximize use of the intervention.
Contact Info, Acknowledgements, and References
Contact Katherine Wiegert at with questions or feedback.
A special thanks to those who helped with this project at the Lowry Clinic: providers, RNs, MAs, pharmacists, pharmacy techs, patient navigators, and—above all—our patients.
Lucy picture courtesy of Peanuts and the estate of Charles Schulz.
§ "Therapeutic Drug Use." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 03 Feb Web. 11 Apr