Thursday, May 14, 2015

Healthcare and Prescription Adherence

Individuals who take medications, especially seniors or those with chronic health issues, are supposed to be taking their prescriptions on regularly scheduled intervals. One of the most critical issues that health plans and medical providers face is the lack of prescription adherence. 

Taking your medications as prescribed is very important to your overall health regimen. Doctors are constantly dealing with patients who either refuse or forget to stay on track. As a consequence, many people suffer from problems related to the lack of consistency with their medications.

Prescription adherence is especially severe with anyone who has a maintenance medication, and does not maintain their adherence due to various reasons—cost, memory, fear, and other excuses. Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication.

Medication non-adherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care, according to the American Heart Association. It’s very important in cardiovascular care. For more details, read material at this website: http://circ.ahajournals.org/content/119/23/3028.full .

People do not realize the real damage or consequences of non-adherence, according to the American Heart Association. When patients with chronic conditions such as cardiovascular disease do not take medication as directed, the repercussions can be severe. For instance, not keeping blood pressure in check can lead to heart disease, stroke, and kidney failure.

In sum, poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations. There are many reasons why people are not able to take their medication as directed.
·         They may forget.
·         They may not be convinced of the medication’s effectiveness or be unsure that it is working.
·         They may fear the side effects or have difficulty taking the medication (especially with injections or inhalers).

And we all know that the rising cost of prescription medications is a barrier for many.
Some may face a combination of these reasons for not taking their medications. One person may face different barriers at different times as he or she manages his or her condition. Whatever the reason, you could miss out on potential benefits, quality of life improvements, and could lose protection against future illness or serious health complications. Much more detailed material on this subject can be located at this site: http://www.heart.org/HEARTORG/Conditions/More/ConsumerHealthCare/Medication-Adherence---Taking-Your-Meds-as-Directed_UCM_453329_Article.jsp

According to the American College of Preventive Medicine (ACPM), poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness. Non-adherence is thought to account for 30% to 50% of treatment failures. Non-adherence leads to worse medical treatment outcomes, higher and avoidable hospitalization rates, institutionalization for the frail elderly, and increased healthcare costs.

Physicians play an integral role in medication adherence. Patients who trust their physicians have better two-way communication with their physician. Trust and communication are two elements critical in optimizing adherence. Numerous studies show that physician trust is more important than treatment satisfaction in predicting adherence to prescribed therapy and overall satisfaction with care. Physician trust correlates positively with acceptance of new medications, intention to follow physician instructions, perceived effectiveness of care, and improvements in self-reported health status.

A recent meta-analysis of physician communication and patient adherence to treatment found that there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well, according to the ACPM. Statistically, the odds of patient adherence are 2.26 times higher if a physician communicates well. This translates into more than 183 million medical visits that need not take place if strong interpersonal physician/patient communication occurs.
Communication contributes to a patient’s understanding of illness and the risks and benefits of treatment. Hence, the major challenge is to improve:
  • Verbal and nonverbal communication (patient-centered care)
  • Interviewing skills (improved competency)
  • Discussions and provide greater transmission of information (task-oriented behavior)
  • Continuous expressions of empathy and concern (psychosocial behavior)
  • Partnerships and participatory decision-making (patient-centered care)
Among significantly more detailed information and additional statistics located at this website:  http://www.acpm.org/?MedAdherTT_ClinRef , a challenge to improve adherence is clearly stated. Poor adherence to medical treatment is widespread and well recognized, as are its consequences of poor health outcomes and increased healthcare costs. Lack of prescription adherence is estimated to annually cause 125,000 deaths. Consider these other statistics:
  • Overall, about 20% to 50% of patients are non-adherent to medical therapy.
  • People with chronic conditions only take about half of their prescribed medicine. 
  • Adherence to treatment regimens for high blood pressures is estimated to be between 50 and 70 percent. 
  • 1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year.
    • Underuse of anticoagulant therapy for prevention of thromboembolism is attributed to the risk factors of younger age, male gender, low overall stroke risk, poor cognitive function, homelessness, higher educational attainment, employment and reluctant receptivity of medical information.
  • Rates of adherence have not changed much in the last 3 decades, despite WHO and Institute of Medicine (IOM) improvement goals.
  • Overall satisfaction of care is not typically a determining factor in medication adherence
  • Adherence drops when there are long waiting times at clinics or long time lapses between appointments.
  • Patients with psychiatric disabilities are less likely to be compliant.
According to a new national poll by Greenberg Quinlan Rosner Research and Public Opinion Strategies, 40 percent of American adults suffer from some form of chronic illness, ranging from diabetes and cancer to heart disease and high blood pressure. In recent years, however, lack of regular adherence to medications has resulted in higher health care costs and an increase in the prevalence of chronic conditions that directly impact patient health. In fact, nine out of ten patients who adhere to their prescription medications describe their health as “good” or “excellent,” while two thirds of patients with poor adherence report the same.

A growing body of evidence suggests that medication adherence programs have the potential to reduce health spending and, in the process, generate significant savings for taxpayers. Policies to promote medication adherence have the potential to improve health and significantly reduce health spending, according to this organization: http://adhereforhealth.org/who-we-are/medication-adherence/ .

There are some tools that can help remind people to take prescriptions. This particular website includes ways to keep track of your medicines, how-to videos about taking your medicine, and tips to help you talk with your doctor or pharmacist about your health problem and your medicine. For more information, go to this site: http://www.scriptyourfuture.org/tools/ .

The average adherence rate (the degree to which patients correctly follow prescription instructions) for medicines taken only once daily is nearly 80%, compared to about 50% for treatments that must be taken 4 times a day. As many as 75% of patients and 50% of chronically ill patients fail to adhere to or comply with physician prescribed treatment regimens.

In a poll (Med Ad News 02/2010) of U.S. individuals 65 years old and older who use medications, researchers found that 51% take at least five different prescription drugs regularly, and one in four take between 10 and 19 pills each day. 57% of those polled admit that they forget to take their medications. Among those using five or more medications, 63% say they forget doses, compared to 51% among those who take fewer medicines. This website offers solutions for products to assist with prescription adherence: http://www.epill.com/statistics.html .

Remembering to take your medicine is the key to compliance. Medicine will be effective only when taken as prescribed by your physician. If you are a caregiver for someone who needs prescriptions taken on a daily basis, your responsibility to help them follow their regimen is especially important. According to the Rosalynn Carter Institute of Georgia Southwestern College, there are 25 million non-professional caregivers in the U.S., and 80% of those are women. Between 80% and 90% of people taking medications receive them from a family member. That’s why it is critical to be adherent to medication therapies.

Prescription adherence is such a huge health care issue in America that Congress is considering ways to mandate options to make it happen better. Organizations that promote adherence are all about education and awareness for the public to know how important the issue is relative to the population at large and the overwhelming costs to the economy. All stakeholders in the medical community--doctors, clinics, hospitals, health plans, pharmacists, etc--are in full stress mode to monitor and maintain the highest degrees of medication adherence.

If you are on regular prescriptions for maintenance medications, keep your schedule intact as much as possible and follow the instructions of your doctor and pharmacist. Even if your medication need is temporary, such as an antibiotic or other short term prescription, follow the directions.  Not only does this help you, but it provides safety and comfort to those around you. Plus, it reduces the possibility of a recurring illness or relapse.


Until next time.

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