Americas Other Drug Problem - Medication Adherence

Dec. 21, 2011 - PRLog -- If medication adherence was a disease, it would be an epidemic.

“Drugs don’t work in patients who don’t take them.” – C. Everett Koop, MD

World Health Organization reports that approximately 50% of patients follow their doctors’ orders when it comes to taking prescription medication, for example only 43% of patients take their medicine as prescribed to treat acute asthma.  51% of patients who are prescribed high blood pressure medication and patients who are prescribed medication for depression or anxiety, adherence is even more alarming.  ¹ Of growing concern is the nonadherence in patients with cardiovascular disease.

There are many reasons for patients’ not taking prescribed medications; The World Health Organization has categorized potential reasons for medication nonadherence into 5 broad categories that include patient, condition, therapy, socioeconomic, and health system–related factors.^2-3 Examples for each of these categories are detailed in this Table.

Medication adherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that nonadherence is prevalent and associated with adverse outcomes and higher costs of care.

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Nonadherence to medications is common for patients with cardiovascular diseases. After acute myocardial infarction hospitalization, Jackevicius et al ⁴ found that almost one fourth of patients ≈24% did not even fill their cardiac medications by day 7 of discharge. Among patients discharged with prescriptions for aspirin, statin, and β-blockers after acute myocardial infarction, 1 study found that ≈34% of patients stopped at least 1 medication and 12% stopped all 3 medications within 1 month of hospital discharge.  ⁵ Medication nonadherence is associated with worse patient outcomes, which supports the need for interventions to improve medication adherence.

Sokol et al ⁶ reported that greater adherence to medications for chronic conditions such as hypertension, diabetes mellitus, hypercholesterolemia, and heart failure was associated with higher medication costs.

A larger number of studies have evaluated the impact of changing costs of medications on individual patient adherence. Among Medicare+Choice beneficiaries, patients who had drug benefit caps were more likely to be nonadherent to medications for hypertension, hyperlipidemia, and diabetes.⁷  On addition, patients with caps on drug benefits had worse intermediate outcomes (eg, LDL levels and blood pressure) and higher rates of emergency department visits and nonelective hospitalizations. In separate studies, changes to out-of-pocket spending doubled the risk of stopping statin therapy, and higher copayments were associated with lower adherence to statins.^8-9

These studies suggest that medication costs can have a significant impact on nonadherence.  There is a solution and together we can bring healing to an ailing America.  There are free patient assistance programs available that can improve medication adherence and clinical outcomes.  One such program is the Community Assistance Program (CAP) which is accepted by most pharmacies and offers patients substantial discounts on all FDA approved medications.  Programs such as Prescription Assistance Program (PAP) are run by pharmaceutical companies to provide medications to people who cannot afford to buy their medication; Rx Med Assist administers these programs at no cost to the clinician.  Another program is the CAP Diabetic Program which provides free glucose meter, lancing device, ultra-thin lancets, carrying case and shipping as well as substantial savings on test strips to diabetic patients.  You can learn more about these programs by visiting http://www.YouSaveMore.org

Simple, evidence-based strategies can be implemented, such as reducing the number of daily doses of medications, organizing medications in pill boxes, using motivational interviewing, providing patients with resources for free community based prescription savings programs as mentioned above, and educating patients on the importance of medication adherence.  ¹⁰ In addition, if feasible, it may be helpful to have clinical personnel follow up with patients through telephone calls to ensure that patients are taking their medications as directed, particularly for those who have a history of nonadherence. This strategy may be especially important in the post–hospital discharge setting. While we await additional evidence from studies, these strategies can be easily implemented in routine clinical practice without much additional time or resources to help patients take their medications as prescribed.

Conclusion

¹¹ Nonadherence to medications is common and is associated with adverse outcomes.  Nonadherence is not solely a patient problem but is impacted by both care providers and the healthcare system.  As the first step toward improving adherence, there needs to be a broader recognition of the problem of nonadherence, and once identified, simple strategies like those mentioned above should be implemented in daily practice to improve adherence.

References:

1)   P. Michael Ho, MD , PhD; Chris L. Bryson, MD, MS; John S. Rumsfeld, MD, PhD Medication Adherence, its importance in cardiovascular outcomes  
Abstract/Full Text
2)   World Health Organization. 2003. Adherence to Long-Term Therapy: Evidence for Full Text
3)   Mochari H, Ferris A, Adigopula S, Henry G, Mosca L. Cardiovascular disease knowledge, medication adherence, and barriers to preventive action in a minority population. Prev Cardiol. 2007; 10: 190–195.
CrossRef - Medline
4)   Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008; 117: 1028–1036.
Abstract/Full Text
5)   Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, Fireman B, Newhouse JP, Selby JV. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006; 354: 2349–2359.
CrossRef - Medline
6)   Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005; 43: 521–530.
CrossRef - Medline
7)   Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, Fireman B, Newhouse JP, Selby JV. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006; 354: 2349–2359.
CrossRef - Medline
8)   Schneeweiss S, Patrick AR, Maclure M, Dormuth CR, Glynn RJ. Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment. Circulation. 2007; 115: 2128–2135.
Abstract/Full Text
9)   Gibson TB, Mark TL, McGuigan KA, Axelsen K, Wang S. The effects of prescription drug copayments on statin adherence. Am J Manag Care. 2006; 12: 509–517.
Medline
10)   Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med. 2004; 164: 722–732.
Abstract/Full Text
11)   Setoguchi S, Glynn RJ, Avorn J, Mittleman MA, Levin R, Winkelmayer WC.  Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. J Am Coll Cardiol. 2008; 51: 1247–1254.
Abstract/Full Text

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Community Assistance Program (CAP) is a free program Helping the Uninsured and the Under Insured across the United States, Puerto Rico and the Virgin Islands, which has saved cardholders over $200,000,000.00 in prescription savings since October 2009.