“Drugs don’t work in patients who don’t take them.” − Former U.S. Surgeon General C. Everett Coop
While it seems obvious, the amount of attention given to adherence is extremely low, especially in comparison to the high costs associated with non-adherence. A recent review published in the Annals of Internal Medicine estimated that a lack of adherence causes nearly 125,000 deaths, 10% of hospitalizations and between $100–$289 billion a year in healthcare costs. Yet we focus more attention on patient diagnosis than on adherence once treatment orders have been established.
Addressing adherence begins with improving patients’ and their caregiver’s perception of the value of each medication prescribed. It has been said that the primary driver of non-adherence is the patient’s lack of appreciation for the benefit of a particular medication. As a result, the patient’s effort to maintain adherence is extremely low. Of course, there are two sides to this story. Besides increasing the perception of a treatment’s value, pharma needs to balance the value/benefit against treatment costs. As a result, reducing the costs can improve the likelihood of adherence.
This also means reducing costs throughout the patient journey, which involves three key steps:
- Diagnosis and treatment
Diagnosis and treatment are the primary starting points, although efforts can take place even prior to these steps through a positive promotion of treatments. Throughout this process, the HCP is critical in stressing the importance of each medication as well as setting realistic adherence expectations and potential adverse events. Resources provided from the pharmacy and consultant pharmacist can assist in providing patients with this information as well.
The second step of the patient journey involves the delivery of medications to the patient, either for the initial prescription or refills. This step can be improved through a “meds@beds” program in which meds are available directly at the point of care or via home delivery, thus avoiding abandonment of prescription at the pharmacy.
Finally, the management of medications can be improved through patient reminders, specialized adherence packaging and medication management devices. Shifting away from vials that lack these critical elements of reminders, tracking and managing and toward innovative medication management systems that are available through a patient’s pharmacy can improve adherence.
Beyond establishing the value of medications to patients by providing education on the benefits and reducing costs, providing additional assistance through each of the three major patient journey steps is critical. When the patient journey is improved, adherence can be part of the continuous quality improvement loop. Then patients can be regularly assessed for adherence through refill tracking and home visits to identify adherence issues and patient understanding of their treatment. Through addressing these challenges and opportunities within medication adherence, improved clinical and financial outcomes can be realized.
Richard has focused his career on improving health outcomes, especially for some of the most vulnerable populations. This has been achieved through several avenues, beginning with his continued active role as a treating internist/geriatrician.…