by Sean D. Teare, president
“Medication adherence is America’s new drug problem,” so says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality with the Department of Health and Human Services. Unfortunately, Dr. Clancy is correct. The following statistics on medication non-adherence paint a troubling picture:
|Annual excess medical costs due to non-adherence
|Number of deaths annually in US due to non-adherence
|Percentage of patients who never even fill their prescriptions
|Average rate of patient non-adherence
The problem is both epidemic and systemic. Even though in the end it is the patient who is non-adherent, there is plenty of responsibility in the healthcare system to pass around. Whether you examine the problem from one of the stakeholders’ perspectives (patient, physician, provider or payor) or you look for a solution, the first step is to admit the problem is systemic.
Medication non-adherence exists because there is a gap in our healthcare system. For the typical patient, management of their medications is left in their own hands. Patients move in a circle that starts with a physician’s consultation which leads to a prescription; they proceed to a pharmacy where the medicine is dispensed and then they are left on their own to follow their medication regimen. The process often stops just when treatment is about to take place. This happens because the cycle of care is not a closed circuit.
Closing the circuit requires real patient education on the importance of taking his/her medication(s). However, the system is not currently designed to provide the time or an incentive for education, empowerment, goal setting and behavior change. The current system lacks the proper incentives, protocols and support mechanisms to improve adherence.
Patients find themselves taking medication just because a doctor prescribed it. Rarely, are they asked to consider what health or lifestyle goals they want to achieve by taking their medication. Seldom is a connection forged between the kind of life the patient would like to lead, and the role medication can play in helping to make this a reality.
So what should an effective adherence solution look like? There are many ways to address the problem, but a viable adherence program should:
- Empower patients to take control of their medication regimens
- Work with the current initiatives, budget and strategy of the healthcare organization that is paying for the care
- Work across all disease states, age groups and demographics
- Employ patient-centered and adaptable pharmacy interventions
- Provide one-to-one education and support
- Scale according to payors’ needs through the use of technology
- Provide actionable outcomes data
If viewed as a subset of disease management, adherence becomes a problem that can be addressed with an effective program. One could make the argument that adherence is one of the easiest behavioral healthcare initiatives to implement, especially when compared with smoking cessation, exercise, diet and weight loss programs. The challenge of altering human behavior is significant, but by employing new tools and technologies in creative ways, we have an opportunity to deliver education, communication and interaction as the cornerstones of behavioral change.
Whether you view medication adherence programs as an investment in patient education or simply as risk-mitigation, the financial rewards are real. A recent study conducted by Medco Health Solutions found that for diabetes patients, every additional dollar spent on medication saved seven dollars in medical cost. A clinically sound adherence program has the potential to make a rapid impact on ROI.
Managing prescription drugs is a challenge for everyone in the healthcare system. The drain on the system both in terms of costs and resources is immense. Prescription medication non-adherence ripples out across the healthcare continuum causing 300 billion dollars in related costs. But through empowerment, education and technology, and a committed and unified effort from all healthcare stakeholders, adherence can be improved, dramatic savings can be realized and patients’ lives can be improved.
Sean D. Teare is the President of InnovationRx. InnovationRx, the healthcare division of the Innovation Group, provides prescription adherence solutions in a research partnership with the Northeastern University School of Pharmacy.
1. Balkrishnan, R. 2005. The Importance of medication adherence in improving chronic disease related outcomes. Med Care 43:517-520
2. Norman, G. “It takes more than Wireless to unbind Healthcare.” Presentation at Healthcare Unbound 2007 Conference.
3. Norman, G. “It takes more than Wireless to unbind Healthcare.” Presentation at Healthcare Unbound 2007 Conference.
4. Balkrishnan,R. 2005. The Importance of medication adherence in improving chronic disease related outcomes. Med Care 43:517-520