Poster detailing the use of an alliance measure in routine pharmacy practice showing increased compliance with medication as prescribed.

1. Incorporating the Therapeutic Alliance Technique into Your Community Pharmacy Practice
Tara Bastawrous, PharmD Candidate 2015, Melissa Somma McGivney, PharmD, Kim Coley, PharmD, Jan Pringle, PhD
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
INTRODUCTION
THE PROBLEM: NON-ADHERENCE
1.Describe the problem of non-adherence to medications and the
importance of TA motivational interviewing.
2.Describe how to incorporate the TA technique during a “first fill”
interview in a community pharmacy setting.
3.Utilize a “Therapeutic Alliance Survey” to assess the
collaborative bond between the patient and the pharmacist after
implementation of the TA technique.
•The World Health Organization estimates 157 million Americans in 2020 will be
affected by at least one chronic disease state. 1 Chronic diseases are the leading
causes of morbidity and mortality in the U.S., accounting for about 70% of death.2
•According to the CDC, about 20-30% of prescriptions are never filled and about 50%
of medications are not continued as prescribed.1
•Incorporating the Therapeutic Alliance (TA) technique into your community pharmacy
practice has the potential to improve adherence to medications and improve patient
satisfaction.
• Adherence: the extent to which a person’s behavior-taking medications,
following a diet, or making healthy lifestyle changes-corresponds with
agreed-upon recommendations from a health care provider1
• Medication Adherence: the patients conformance with the providers
recommendation with respect to timing, dosage, and frequency of
medication-taking during the prescribed length of time1
• According to the CDC1
• 51% of Americans treated for HTN are adherent long term
• 25-50% of patients on statins discontinue treatment within one year of
starting therapy
• Leads to $2000 per patient in physician visit annually
OBJECTIVES
• Medication therapy management is becoming increasingly important in improving patient outcomes.
However, the patient-practitioner relationship may be even more important.
• As the most accessible health care providers, community pharmacists serve as vital patient advocates in
impacting health behaviors.
Meyer, R. Non-adherence tied to high co-pays 5
THERAPEUTIC ALLIANCE
• TA was first described in the setting of psychotherapy, but has spread
throughout the healthcare community as a basis to establishing an important
relationship between the patient and their health care providers.3
• The TA technique, establishing trust and care with the patient, was used to
enhance the patient experience during an original fill of maintenance
medications. Brief surveys, based upon Scott Miller’s Session Rating Scale
(SRS), were administered after the interaction, assessing the patients
“collaborative bond” with his/her pharmacist. 3,4,5
• Pringle and colleagues found3:
• “Healthcare provider and his or her patients are equals, with both parties
making decisions and acting together toward common goals.”
• “Pharmaceutical care requires a much more intimate and intensive
relationship between the pharmacist and patient than simple
pharmaceutical dispensing.”
• “Pharmacist competence, trustworthiness, and caring are core of the
therapeutic alliance between a pharmacist and his/her patients.”

2. I would like to thank Dr Smith, Dr. Bacci, members and coordinators of the Community, Leadership, & Innovations in Practice group,
Dr. Scott Miller who developed the SRS Scale, and Dr. Pringle for her work on Therapeutic Alliance between the pharmacy and patients.
TA PROCESS
This study was determined exempt by the University of Pittsburgh Institutional Review Board
Patients are encouraged to enroll in pharmacy adherence
programs such as automatic refill, refill synchronization,
text messaging alerts, and smart phone medication
adherence apps to help manage their medications
Patients are then asked to answer the
“therapeutic alliance” survey to assessing
their “collaborative bond” with the
pharmacist
Patients are given a disease specific brochure and are
encouraged to call their pharmacist with any questions
or concerns, establishing an important relationship
The pharmacist or intern utilize “therapeutic
alliance” interviewing, counseling patients on
potential root causes of non-adherence and the
importance of refilling their medications
The patient is asked to spend a few minutes
discussing their new medication with their
pharmacist
Patient presents to the pharmacy to pick up a
new maintenance medication for the first
time
PRELIMINARY RESULTS
CONCLUSIONS
• Brief communications incorporating TA assessment is a small change that can be
incorporated into any pharmacy workflow, but has a great impact on patient medication
adherence.
• Enhancing the therapeutic relationship between pharmacists and their patients can
significantly improve patients’ health behaviors including medication adherence as well as
the overall effectiveness of MTM encounters.
• Repetitive administration of therapeutic alliance surveys encourages pharmacists to
interview patients and “actively listen” to their concerns, providing a mechanism to receive
feedback from patients.
• Use of a personalized approach to care positively impacts patients health behaviors. This
approach establishes trust between the patient and his/her pharmacy team, empowering
them to manage their medications and disease states.
1.Chowdhury F, Patel D, George M, et al. Strategies to improve medication adherence. Center for Disease Control and Prevention.
http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf. 2013
2.Albrecht S. The Pharmacist’s Role in Medication Adherence. U.S. Pharmacist. 2011
3.Pringle J, Melczak, Alridge A, et al. Medication adherence and its relationship to therapeutic alliance: results from an innovate pilot study with a
community pharmacy MTM practice. INNOVATIONS in pharmacy. 2011
4.S Miller. Personal communication with M. Melczak. November 2008.
5.Duncan B, Miller S, et al. The Session Rate Scale: Prelimary Pschometric Properties of a “Working” Alliance Measure. Jounral of Brief Therapy.
2003. (5)
6.Meyer, R. Non-adherence tied to high copays. http://worldofdtcmarketing.com/non-adherence-tied-high-copays/cost-of-healthcare-in-the-u-s/. 2014
• We surveyed 20 patients after
utilizing the TA technique during a first
fill process and 18 of 20 (90%)
scored a 10/10 on the TA Session
Rating Scale4.5.
• The TA survey can be used to assess
patient feedback with the interaction
and serve as a catalyst to determine
how to improve future encounters.
ACKNOWLEDGEMENTS
Incorporating the Therapeutic Alliance Technique into Your Community Pharmacy Practice
Tara Bastawrous, PharmD Candidate 2015, Melissa Somma McGivney, PharmD, Kim Coley, PharmD, Jan Pringle, PhD
University of Pittsburgh School of Pharmacy, Pittsburgh, PA
REFERENCES