Wellness and Chronic Diseases Management Services
The Case for Wellness and Chronic Diseases Management Services Offered by Pharmacists
What are wellness and chronic disease management services?
Wellness services provide patients with support, guidance and education to help them better manage health conditions that can affect their quality of life and day-to-day living. Wellness services are geared to supporting patients with:
- Chronic disease management (like diabetes, cardiovascular disease, respiratory disease, cancer, mental disorders and arthritis)
- Treatment of mental health issues
- Participation in lifestyle management programs (such as smoking cessation)
If not properly managed, these conditions can lead to more serious health issues or develop complications that may result in more costly healthcare interventions.
How can pharmacists help?
Advantage to plan member
Quick access to advice, support and information to better prevent or manage a chronic condition, improve a patient’s quality of life and help effectively prevent complications that may require more extensive and costly treatments or hospitalization.
Advantage to employer
Managing chronic illnesses helps improve overall employee health and productivity, reducing the cost of medical absences and drug costs. It also helps reduce the incidence of short and long-term disability.
Advantage to plan
Improved adherence to medications helps ensure patients realize the full benefits of the recommended therapy. Reducing the risk complications and the incidence of short and long-term disability saves on the overall costs to the plan.
An increasing number of Canadian companies are launching workplace wellness programs to manage the rising costs of drugs, reduce absenteeism and lower STD and LTD rates. Pharmacists can play an important role as part of the health care delivery by providing accessible education and support for health management.
For patients with one or more chronic conditions, pharmacists can play a vital role in helping them better manage their condition and improve their quality of life. Better self-management reduces the possibility of complications developing; leading to more expensive treatment options, additional time off work, or the possibility of short-term or long-term disability. Providing support for prevention programs such as smoking cessation helps patients address risk factors that contribute to chronic illness.
The accessibility of pharmacists and the existing relationship patients already have with their pharmacist make wellness services a natural extension of a pharmacist’s role as a partner in health care delivery.
Through wellness services pharmacists provide front line support that focuses on:
- Improving patient adherence to medication
- Educating patients to help them understand the benefits of a prescribed treatment program and prevent relapses
- Coaching to gain greater involvement by the patient in their own health care treatment (self-management helps prevent a condition from progressing into a more chronic state)
- Promoting health and prevention of risk factors through support for lifestyle management programs such as smoking cessation
Case study example
Here’s how one woman was able to find support from her pharmacist to better manage her chronic condition and change the outcome of her health story (names have been changed to protect privacy).
The case for wellness and chronic disease management services
- Lack of adherence to medications can lead to a relapse or complications that may require a more costly medical intervention
- Many chronic conditions are preventable when health risk factors such as obesity, smoking, poor nutrition and alcohol consumption are addressed through participation in lifestyle management programs
- Lack of patient understanding about the benefits of a prescribed treatment can lead to non-adherence – leading to complications, higher absenteeism and higher health plan costs
By providing wellness education and support services, pharmacists can help patients better manage their health, which leads to a reduction in absenteeism and presenteeism, improved productivity, and lower overall cost of an employer’s health plan.
At 55, Margaret, a Director of IT was on multiple medications to help manage her type 2 diabetes. Her doctor recommended she become more physically active, but Margaret had concerns because at certain times of the day she felt shaky and weak. As a result, she was concerned about her energy levels and of falling while walking to a meeting.
She spoke to her pharmacist, Iris Bertrand, BScPhm, about her concerns. After reviewing the woman’s medication regimen in the context of her symptoms, the Hamilton-based pharmacist suspected hypoglycemia. Iris contacted Margaret’s doctor to recommend a different drug to manage her condition. The physician agreed and with the change in medication, Margaret’s condition and quality of life soon improved.
“She was just delighted and felt much better,” Iris says, pointing out the simple adjustment prevented a possible fall that could have led to other serious health issues, such as a hip fracture, absenteeism leading to potential short term disability.
The business case for plan sponsors
An estimated 16 million Canadians1 live with a chronic condition; some live with more than one. The economic impact is staggering not only in the direct health care costs, but also in terms of absenteeism and lost productivity related to the patients themselves and family members who care for them.
According to the Public Health Agency of Canada, “More than half (58%) of all annual health care spending in Canada is for chronic diseases, at a cost of $68 billion a year.” The indirect cost in terms of income and productivity losses was estimated at $122 billion in 2010.2 Mental health conditions and addictions are also on the rise in Canada accounting for approximately two-thirds of all disability insurance claims according to the Conference Board of Canada in 2012.3
As staggering as these costs are, the truth is that many chronic conditions are preventable. Wellness services and the support of pharmacists can go a long way towards helping patients better manage their health and reduce their risk factors through prevention programs. Studies have shown that 80 percent of type 2 diabetes and heart disease cases and 40 percent of cancer cases are linked to lifestyle risk factors such poor nutrition, obesity, smoking, inactivity or alcohol consumption.4 5
Adherence to medication is a major contributor to complications for patients with chronic conditions. According to the World Health Organization, in developed countries only 50% of patients with chronic diseases adhere to treatment recommendations.6 The result is poor health outcomes and increased health care costs. However, the report also finds that improving adherence rates would provide a significant return on investment through prevention of risk factors and adverse health outcomes.
Chronic disease management (CDM) in action
The patient initiates the process by asking about the CDM program with their community pharmacist. Generally, medication reviews require the patient to be on several prescription drugs, as is often the case with chronic diseases. If the patient meets the criteria, an appointment is scheduled.
The review is carried out in a private counselling area and normally takes 15 minutes to an hour depending on the complexity of the patients’ medications.
The patient is asked to bring a complete list of medications they currently take including all prescription, over-the-counter, and alternative medications, including vitamins.
The pharmacist uses this information to evaluate possible drug interactions or adherence issues; comparing the provided patient prescription medication list to what they may have on file.
The pharmacist may make adjustments to current drug therapy regimens, counsel on other areas for overall health improvement, and provide additional services/resources to aid the patient in achieving optimal health.
At the end of the appointment, the pharmacist can address any concerns and provide the patient with a complete-updated list of their current medication regimens.
Wellness and chronic disease management services provided by a pharmacist deliver important and measurable benefits to employees, employers, and health plans. In addition to helping improve the quality of life for patients living with a chronic condition, and supporting participation in prevention programs that address common health risk factors, these wellness services help reduce direct health care costs, absenteeism and presenteeism; and increase productivity. Through the most accessible health care services, pharmacists can provide the support, guidance and education patients need to better manage their health and wellbeing.
1 Transforming Care for Canadians with Chronic Health Conditions, Canadian Academy of Health Sciences report, Fall 2010 p. 11
2 Backgrounder, United Nations NCD Summer 2011, Public Health Agency of Canada
3 Making the Business Case for Investment in Workplace Health and Wellness, The Conference Board of Canada June 2012, p. 3
4 Kenneth, “Keynote Presentation.” American College of Preventive Medicine Prevention 2008 Conference. Austin, Texas, 2008.
5 Loeppke, Ronald. “The Value of Health and the Power of Prevention.” International Journal of Workplace Health Management1, no. 2 (2008): 97.
6 Adherence to Long-Term Therapies, World Health Organization 2003