Overcoming Patient Medication Adherence Barriers
To paraphrase the World Health Organization, to make the world healthier, the primary goal shouldn’t be to create new medications, it should be to figure out how to get patients to take the meds we already have.
A staggeringly high number of Americans are non-adherent with medication. The National Council for Patient Information and Education says about half of the 2 billion prescriptions written each year in the U.S. either go unfilled or end up being taken incorrectly. Nearly a quarter (24%) of patients either don’t fill their prescriptions, or fill them but never take them. Another 29% stop taking them before their meds run out, and 22% try to cut corners by taking less medication than prescribed.
Pervasive non-adherence, says the Journal of Applied Research, is responsible for about a quarter of all nursing home admissions, about $8.5 billion a year in additional hospital costs, and about 125,000 deaths per year.
Prescription for non-adherence
Combating the problem is complex, largely because so many factors can be involved. At the most basic level, a 2008 study of how well patients understood 10 sets of prescription label instructions found that clarity ranged from 53% to 89%. But even when patients understand their prescriptions, there’s no guarantee that they’ll follow through. Another study found that by far the biggest reason people didn’t take their meds was that they simply forgot.
Others stop taking meds because they don’t like the side effects or because they’re non-symptomatic — they don’t feel any different when they take them, so why take them?
More recently, researchers are finding yet another primary cause: Drug prices and health-plan deductibles are rising, and the financial toll feels too steep for millions of people. A recent Consumer Reports survey found that 22% of those on prescription meds had seen the price of at least one medication go up in the past year. Those folks were often resorting to “desperate measures,” such as rationing meds by taking them less often, splitting their pills, taking expired medications or simply not filling their prescriptions.
But don’t just blame patients, say experts. There are also plenty of factors beyond the control of those being given the prescriptions.
It’s about value
Physicians may inadvertently contribute to non-adherence by prescribing complex drug regimens and by failing to explain both the benefits and the potential side effects to patients. Moreover, many need to do a better job of recognizing the signs of medication nonadherence.
The system itself can be an impediment. When overworked physicians are seeing a large number of patients in short intervals, they may not have enough time to adequately assess whether patients are adherent. Nor might they have time to discuss the importance of adherence or strategies patients can use to improve.
Physicians may also need to be more aware of potential financial burdens. The Consumer Reports survey found that most people didn’t know what their meds were going to cost until they got to the drug store. And 85% percent of respondents said physicians should ask patients whether they can afford their drugs, the assumption being that they may be able to steer them toward less-expensive alternatives, when necessary
It’s worth noting that the trend toward value-based reimbursements further incentivizes physicians to ensure that patients are adherent.
Better tools and better communication
Better communication and the implementation of high-tech tools, such as predictive analytics and integrated data systems, are likely the key to improved adherence. Physicians may be able to identify patients who are more likely to be non-adherent by analyzing both past behaviors and personal characteristics.
But a few non-judgmental questions can also go a long way. Patients may list their medications during a routine office visit, but that doesn’t mean they’re taking them. A combination statement/question like, “I know it must be difficult to take all your medications regularly. How often do you miss taking them?” may go a long way toward painting a more complete picture. Other possible questions to ask include “Of the medications prescribed to you, which ones are you taking?” or “Have you had to stop any of your medications for any reason?”
Such a patient-centered approach might also uncover other opportunities. For instance, if a diabetes patient expresses a preference for herbal remedies, he or she might be reassured to learn that metformin is derived from the French lilac.
The CareThrough solution
Another approach? CareThrough navigators specialize in freeing up physicians to concentrate on the clinical side of their practices, freeing them from the tedium of other tasks. Navigators are also trained to build relationships with patients and motivate them. By establishing trust, navigators can strategize with patients to help ensure, among other things, that at-risk patients successfully manage their care and always take the medication they need, when they need it.