Multidisciplinary and Pharmacy-Based Strategies for Improving Medication Adherence

Author: Michael R. Page, PharmD, RPh

MEDICATION NONADHERENCE has been documented since ancient times, when Hippocrates wrote, “Keep watch also on the faults of the patients which often make them lie about the taking of things prescribed.”

Unfortunately, nonadherence continues to this day. As the late great Surgeon General C. Everett Koop, MD, said, “Drugs don’t work in patients who don’t take them.”

Today, with an estimated 50% to 66% of patients failing to take medication as prescribed, with 17% of the United States gross domestic product spent on health care, and with 75% of those costs related to chronic condition management medication, nonadherence is a larger problem than ever.1-3

Low adherence rates are the cause of 33% to 69% of medication-related hospitalizations. In patients with hypertension alone, nonadherence is responsible for approximately 86,000 premature deaths in the United States every year. The annual economic costs of medication nonadherence are estimated at $100 billion, and according to statistics from the Network For Excellence In Health Innovation, the cost of avoidable drug-related problems, including nonadherence, costs society approximately $290 billion each year.4-7

The costs of nonadherence rapidly diminish as adherence improves. For instance, in patients with diabetes, each 10% increase in medication possession ratio rates reduces overall health care costs by 9% to 29%.

In fact, for the most adherent patients with diabetes, medical costs are halved versus the least adherent patients ($8867 vs $4570). Similarly, in a 2000 study of a Medicare population with multiple chronic disease states, for each additional prescription filled, hospital-related costs fell by $104 per patient, or approximately 5% overall.8-11

Several methods have been proposed for improving adherence including12,13: For instance, in patients with diabetes, certain erroneous beliefs were associated with less consistent medication use.

These misconceptions about medications include statements like14: Ultimately, education is the key to improving adherence. For managed care plans, investing in medication adherence initiatives is a winning proposition.

It has been estimated that for every dollar spent on medication adherence initiatives for patients with diabetes, $7 in health care costs are saved (Figure 1).

By some estimates, improved adherence in patients with diabetes alone could save $8.3 billion per year.8-11

Given that physicians have little time with patients and that pharmacists are the most accessible health care providers, improving adherence is an important opportunity for pharmacists to improve patient outcomes. Many studies show the value of pharmacists in improving patient outcomes through adherence-promoting initiatives.

For instance: Pharmacists use a variety of methods to promote adherence. In a 2011 survey of pharmacy managers at 162 health care organizations, interventions for improving adherence included individual coaching, medication reconciliation, MTM, telephonic reminders, postdischarge calls, and home visits, among others (Figure 2).19

Team care using the entire health care team has been demonstrated to improve adherence. For example, in a 12-month study, patients receiving team care experienced a nearly 3-fold increase in adherence among patients receiving insulin (P <.001), a near doubling in antihypertensive medication adherence (P <.001), a greater than 3-fold increase in blood pressure monitoring rates (P <.001), and a 28% increase in glucose monitoring rates (P = .006).20

Pharmacists can improve adherence in several ways, including through individualized coaching, refill reminders, and medication synchronization. In 2014, nearly three-fourths (74%) of independent community pharmacists offered MTM services, and approximately two-thirds (67%) offered programs to improve patient adherence.

As the pharmacy profession continues to evolve, pharmacists will become an increasingly important part of the move toward improving adherence by reducing regimen complexity for patients, correcting misconceptions, and ensuring that patients understand the benefits and risks of therapy.21 SPT

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MICHAEL R. PAGE, PHARMD, RPH, earned his PharmD from the Ernest Mario School of Pharmacy at Rutgers University. He has worked as a community pharmacist at CVS Pharmacy and is currently clinical editor in clinical and scientific affairs at Pharmacy Times.