First-Fill Counseling – MO Pharmacy Adherence Month

As thousands of students take the Oath of a Pharmacist at white coat ceremonies around the country, it’s a good time to reflect on the professional pledges we’ve made and the responsibilities that come with them.

Upon entering the profession, we dedicated ourselves to a lifetime of service to others and to fulfilling this vow: promising to “apply our knowledge, experience, and skills to the best of our ability to assure optimal outcomes for our patients.” Pharmacists have progressed in being recognized for our positive impact on health outcomes, as evidenced by the passage of pharmacy specific provisions in the health care reform legislation earlier this year. But the issue of medication non-adherence remains a perplexing puzzle.

What can pharmacists do to help their patients remain adherent? Simply letting them know that you care about their health can facilitate dialogue and build on trusted relationships. One way to encourage patients to open up about their medications is through a concept known as “first-fill counseling.”

First-fill counseling entails flagging scripts that are for new medications and instructing technicians or clerks to tell patients that a pharmacist would like to speak with them before they check out. This pharmacist interaction can be a critical step in ensuring that the patient will remain adherent to the prescribed course of therapy. Did you know that a third of patients starting on a maintenance medication will stop before their first refill is due, and half of patients with a chronic disease eventually discontinue its use altogether? Explaining the dosing instructions, addressing any concerns the patient may have, helping them simplify their dosing schedule, or counseling on possible side effects can put the patient at ease and on the path to adherence. In the process, you become perceived as a trusted patient advocate.

As grant funding to expand medication therapy management and related initiatives becomes available, the outcomes of non-adherence should continue to be top of mind. Non-adherent behavior is often the cornerstone of medication-related issues that pharmacists are trained to identify, resolve, and prevent.

Reprinted with permission from National Community Pharmacists Association in the September 2010 issue of America’s Pharmacist. For more information about NCPA, visit

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