According to recent estimates, about a third to a half of all patients in the United States fail to comply with their prescribed pharmacotherapy regimens. Failure to adhere to medications can reduce quality of care and increase medical expenses. Costs attributable to non-adherence are about $290 billion each year, and much of this spending stems from complications that result from not taking medications appropriately. “Patients fail to take their medications for many reasons, including difficulty with dosing regimens, costs, side effects, or concerns about drugs in general,” says Walid F. Gellad, MD. “Providers need different strategies and interventions to improve adherence.”

To achieve optimal medication adherence, considerations must be made with regard to effective patient-provider communication, coordination among care providers, and active engagement and participation by patients. “All too often, patients are lacking important information or there are gaps in their communication with providers,” Dr. Gellad says. “For these reasons, it’s critical to identify any opportunities to remove barriers that keep patients from adhering to their medications.”

New Policy Recommendations

On July 15, 2009, several organizations convened more than 40 experts to discuss poor medication adherence in the United States, including GlaxoSmithKline, the National Association of Chain Drug Stores Foundation, the National Consumers League, the Pharmaceutical Research and Manufacturers of America, and the American College of Cardiology. As a result of this meeting, consensus policy recommendations to reduce barriers to adherence were released on October 14, 2009. Using themes that emerged from the July 15, 2009 conference and considering the proposed policies under review by Congress, the resulting recommendations focus on the following key areas: quality improvement strategies, care coordination, use of health information technology (IT), and patient and provider education and engagement (Figure 1).

Quality Improvement & Coordination of Care

Despite the U.S. having an advanced healthcare system, further improvements in quality can and must be achieved. “Given the role that medications play in treating diseases—particularly chronic ones—we must implement strategies to recognize medication adherence and appropriate drug use as critical components of improving outcomes and quality,” explains Dr. Gellad. He adds that care coordination must also improve, and physicians should recognize the importance of medications in settings where care is coordinated for multiple providers and patients.

Technology to the Rescue

Congress invested over $19 billion in the American Recovery and Reinvestment Act of 2009 to help accelerate the development of a nationwide interoperable health IT infrastructure. Policies have been initiated to encourage physicians to use electronic prescribing. Other policy makers are considering different strategies that build upon these reforms and utilize health IT to improve patient care and measure adherence. This information may ultimately help to improve healthcare quality. “The potential for health IT is enormous,” says Dr. Gellad. “It can be used to improve the flow of medication use information between patients and providers at the point of care and during transitions of care. Importantly, health IT can assist in identifying and addressing gaps about patients’ medication use.”

Educating & Engaging Providers & Patients

Patients’ beliefs and expectations about their medications and the availability of social supports can affect patients’ ability to adhere to treatment regimens. Good patient-provider communication is also necessary. “Physicians need to encourage patient-centered care that is designed to help patients better understand their conditions and recommended treatments, including medications,” says Dr. Gellad. “Providers need to establish clear lines of communication about medication adherence with their patients at every encounter. Efforts should support providers in effectively communicating the importance of following treatment plans to patients and their caregivers.” Education, counseling, reconciliation, and other activities that fully engage patients may further improve adherence.

More to Come

Although much is known about the impact of poor medication adherence, more research is necessary to achieve better medication use and improve clinical outcomes (Figure 2). “We have a good understanding of the barriers that patients face in taking their medications appropriately,” says Dr. Gellad, “but we need more research that assesses the effectiveness of interventions to improve adherence. Interventions to reduce barriers to adherence will hopefully help patients and providers achieve better medication use and health outcomes.”

References

Prescription for Healthier Patients: Real Solutions for Better Medication Adherence. Better Medication Adherence is Essential to Improve Health Care Quality, Outcomes and Value. Diverse Group of Key Stakeholders Develop Consensus Policy Recommendations. October 14, 2009. Available at www.nacds.org/user-assets/pdfs/2009/pharmacy/Policy_Recommendations_091014.pdf. Accessed October 29, 2009. 
 
Osterberg L., Blaschke T. Adherence to medication. N Engl J Med. 2005:353:487-497.
 
Gellad WF, Haas JS, Safran DG. Race/ethnicity and nonadherence to prescription medications among seniors: results of a national study. J Gen Intern Med. 2007;22:1572-1578.
 
Gellad WF, Huskamp HA, Phillips KA, Haas JS. How the new medicare drug benefit could affect vulnerable populations. Health Aff (Millwood). 2006;25:248-255.