Ensuring patients adhere to prescribed medications is vital for optimal clinical outcomes. Addressing poor medication adherence involves patient education, cost-related barriers, managing side effects, and innovative strategies like medication synchronization and mail-order pharmacy services. Healthcare providers must employ data analytics, motivational interviewing, and empathetic communication to identify and address the root causes of non-adherence. Collaboration between patients and providers is essential to achieve better adherence rates, ultimately improving healthcare outcomes and cost-efficiency.
Ensuring optimal clinical outcomes for patients suffering from acute or chronic illnesses extends beyond merely prescribing medications or treatments. The key lies in patients actively adhering to their prescribed medications, a practice known as medication adherence.
Medication adherence involves patients following their prescription instructions, which includes filling the prescription and taking the prescribed dose at the specified frequency. Poor medication adherence encompasses instances where patients deviate from these guidelines, such as failing to fill their prescriptions, skipping doses, or altering dosages.
Unfortunately, strong medication adherence remains a challenge. A study published in 2023 in JAMA Network Open revealed that roughly one in five adults with diabetes did not consistently use their glucose-lowering medications between 2005 and 2018. Furthermore, an average of 17 percent and 43 percent of patients did not adhere to their prescribed blood pressure or lipid-lowering medications during the same period.
While the JAMA study primarily focused on diabetes patients, previous data from the Centers for Disease Control and Prevention (CDC) supports these findings. In a 2017 CDC Morbidity and Mortality Weekly Report, it was revealed that healthcare providers issue 3.8 billion prescriptions annually, and one in five of these prescriptions goes unfilled. Among those that are filled, only 50 percent are taken correctly.
Inadequate medication adherence carries significant financial implications, costing the U.S. healthcare industry between $100 and $300 billion each year, according to the CDC report.
Improving medication adherence is a shared responsibility between patients and healthcare providers. Healthcare providers must collaborate with patients to identify barriers to adherence and employ strategies to overcome them.
DATA ANALYTICS FOR IDENTIFYING POOR MEDICATION ADHERENCE
In today’s increasingly digital healthcare landscape, many healthcare providers leverage health information technology (IT) to identify patients who are not following their medication regimens. A literature review published in JMIR MHealth UHealth in 2022 listed various technologies used to monitor medication adherence, including electronic pill bottles or boxes, ingestible sensors, electronic medication management systems, blister pack technology, patient self-report technology, video-based technology, and motion sensor technology. These tools help alert providers when patients fail to take their prescribed medications.
Some healthcare providers also collaborate with payers to flag instances of medication non-adherence. Health payers can examine claims data to identify patients who have been prescribed medications and then assess pharmacy claims to determine whether a patient has filled the prescription.
Once providers have this information, they can work with patients to select the appropriate tools to achieve medication adherence. However, not all healthcare providers can rely on these technologies due to cost constraints, variable data quality, or a lack of collaboration with payers. In such cases, providers must establish trust with patients to obtain self-reported information on medication adherence.
MOTIVATIONAL INTERVIEWING
Motivational interviewing serves as an effective patient-provider communication strategy, particularly for clinicians without access to data on medication adherence. This approach helps uncover the reasons behind a patient’s non-adherence to medication regimens.
Clinicians can initiate discussions with patients by inquiring about their medication usage, dosing routines, and the financial aspect of obtaining medications, especially if out-of-pocket costs are a concern. Understanding how patients manage their medications can shed light on adherence patterns.
It is essential for providers to approach these conversations with empathy and respect, as many patients may be hesitant to admit non-adherence or discuss financial barriers.
Motivational interviewing allows clinicians to explore why patients do not adhere to their medications and collaboratively develop solutions to improve adherence. This approach involves both providers and patients working together to establish health and well-being goals and determine reasonable steps to achieve them.
Ultimately, the best treatment a provider can recommend is one that is affordable and feasible for the patient.
Nevertheless, medication adherence is often influenced by more than just a patient’s willingness to take their medications. Factors such as financial constraints, health literacy, and management challenges can also impede adherence.
COST-RELATED BARRIERS
Cost-related barriers, including out-of-pocket expenses and varying health insurance coverage, are primary contributors to poor medication adherence. Surveys consistently show that when patients cannot afford their prescriptions, they are less likely to fill them.
A study published in JAMA Network Open in 2023 reported that one in five patients encounters at least one cost-related barrier to medication adherence each year. For some patients, this means rationing their pills to extend their supply, while others may avoid filling their prescriptions altogether. A significant number of patients resort to drastic measures, with 8.5 percent forgoing basic necessities to cover medication costs and 4.8 percent going into debt to afford their medications.
Healthcare providers must counsel patients on the affordability of prescription drugs. Using empathetic communication, providers can uncover cost-related barriers and explore lower-cost alternatives or dosage adjustments to make medications more accessible.
The study in JAMA also revealed that patients are open to discussions about medication costs, with 89 percent expressing willingness to engage in such conversations before provider visits. A similar number (89.5 percent) desired the use of a real-time benefit tool by their clinicians.
Policy initiatives are also being introduced to address prescription drug affordability. For instance, the implementation of a $35 insulin cap for Medicare Part D beneficiaries has been shown to improve medication adherence rates.
PATIENT EDUCATION
Medication adherence hinges on patients having a comprehensive understanding of what they are taking, why they are taking it, and how it affects their health. However, patients often lack this level of awareness.
This issue is particularly pertinent for patients who take medications for preventive purposes, as they may not directly perceive the effects of these medications. It can be challenging to demonstrate that adherence to a medication can prevent a health event that has not yet occurred.
A study in the Journal of the American Geriatrics Society in 2021 highlighted how limited awareness and confusion about pill efficacy can hinder adherence, especially in the case of atrial fibrillation medication. Some patients taper their medication because they are unaware of its effectiveness, while others skip doses when they no longer experience symptoms.
Enhancing patient education on medication use, its purpose, and potential side effects is essential for improving adherence. Research indicates that patient education can yield positive results. In 2023, a study from the Johns Hopkins School of Nursing showed that patient education sessions, supplemented with educational materials, increased patient adherence to post-operative blood thinners for preventing venous thromboembolism (VTE).
MEDICATION SYNCHRONIZATION AND DOSE PACKAGING
Complex medication regimens can pose a challenge to patients, particularly those managing multiple chronic conditions or elderly patients. Healthcare providers and pharmacists can implement various strategies to help patients, and sometimes their caregivers, better organize their medication management.
These strategies range from simple medication reminders or alarms to more comprehensive medication synchronization programs that align the refill dates for all of a patient’s prescriptions. Research indicates that these management strategies can improve adherence, with some studies showing a potential increase of up to 3 percent.
Furthermore, medication synchronization has been associated with reduced hospitalizations and emergency department visits, leading to better health outcomes. A Health Affairs study in January 2018 reported a 9 percent increase in medication adherence rates following the implementation of medication synchronization.
Dose packaging, such as blister packs, can serve a similar purpose by helping patients taking multiple medications to keep track of which pills should be taken together and when. By grouping the pills in the same blister or pouch, patients can better adhere to their regimens.
MANAGING SIDE EFFECTS
Side effects, or adverse reactions to medications, can significantly impact adherence. The nature and severity of
side effects depend on the specific medication, but commonly cited side effects include nausea, dizziness, fatigue, headache, constipation or diarrhea, dry mouth, skin reactions, and weight changes.
If a medication causes discomfort or side effects, patients may be less inclined to adhere to their treatment. A study published in the American Journal of Hypertension in 2016 focused on patients taking medication for hypertension and found that 85 percent experienced side effects. Among these patients, 34 percent discontinued their medications due to side effects.
To address this issue, healthcare providers should work with patients to adjust dosages, find solutions to mitigate side effects, or explore alternative treatments with fewer side effects.
MAIL-ORDER PHARMACY
Mail-order pharmacy services involve the delivery of prescription medications through the mail or other home-delivery methods. This approach can help overcome transportation barriers that hinder medication adherence, benefiting patients without access to transportation or those who cannot drive.
The utilization of mail-order pharmacy services has grown over the years, but it remains relatively uncommon. In 2021, an analysis showed that mail-order pharmacy usage increased from 10.2 percent of adult prescription users in 1996 to 17 percent in 2005. However, by 2018, this figure had decreased to 15.7 percent.
Despite not being a widespread practice, some data suggests that mail-order pharmacy can enhance medication adherence. A 2010 report indicated that individuals receiving mail-order prescriptions exhibited medication adherence rates 10 percentage points higher than those who did not. A 2016 literature review also supported the notion that mail-order pharmacy users tend to have higher medication adherence and are more likely to receive incentives for using these services.
However, patients may have concerns about the unpredictability of delivery dates, medication security during shipping, and the coordination of multiple prescription refills when using mail-order pharmacy. To encourage patient adoption, mail-order pharmacy companies and providers may offer incentives or add pharmacy benefits to their plans, such as providing a free one-month supply of medications for signing up.
Medication adherence continues to be a challenge in the management of chronic diseases. As healthcare strives to reduce costs and enhance patient outcomes, healthcare providers must identify patients with low adherence, address the barriers to adherence, and implement strategies to improve adherence rates.
