Thereâ€™s no question that medication adherence is a problem. How big a problem? Well, according to an article in The American Journal of Medicine, 28% of new prescriptions never get filled, and among patients who do fill their prescriptions,Â adherence rates are less than 50%. The problem with these numbers is that they represent not only grief for the patient, but for the entire healthcare system.
According to Dave Walker, a pharmacist that blogs at pharmacy 2.0 and Â½, â€œalthough the causes and proposed solutions to the medication adherence/compliance problem vary widely andÂ are often debated, it seems one thing can be agreed upon by allâ€¦ it is a very costly healthcare problem in the U.S. today. The cost of non-adherence was estimated to be $290 billion annually by theÂ New England Healthcare Institute NEHI in 2009. Itâ€™s now estimated by some to be in the neighborhood of $330 billion or more annually.â€ Thatâ€™s a lot of money.
The problem is well defined, i.e. people arenâ€™t taking their medications properly, but the solution has eluded the healthcare system for a long time. The issue has been debated and discussed as long as Iâ€™ve been a pharmacist. Have we made progress? Itâ€™s hard to say. I suppose it all depends on what your definition of progress it. Looking around today we have lots of medication adherence tools at our disposal. We have reminder systems, mobile applications, smart medication organizers, alert systems for medication bottles, and so on and so forth.
All these toys have a place in medication adherence, but the fundamental problem goes well beyond their scope. Medication adherence is a multi-faceted problem with roots in psychological behavior, socioeconomic background, demographics, etc.
However, as alluded to in Daveâ€™s post mentioned above, it begins and ends with the pharmacist. â€œAÂ recent report published by the National Community Pharmacy AssociationÂ NCPA identified what I believe to be the biggest factor for combating the medication adherence problem: â€œThe biggest predictor of medication adherence was patientsâ€™ personal connection (or lack thereof) with a pharmacist or pharmacy staff.â€â€
A patientâ€™s use of medication should begin by developing a relationship with a pharmacist, and in my opinion that should happen at the point of care, which is often in the hospital. Patients should speak with a pharmacist upon admission, and again upon discharge. No patient should ever leave the hospital without speaking to a pharmacist and without medications in hand. This goes back to my days as a pharmacy student at UCSF. As part of my fourth year general medicine rotation it was my job to interview each patient that was admitted to my teamâ€™s service. I was responsible for ascertaining their medication use and beginning the medication reconciliation process. Upon discharge it was my job to have the patientâ€™s prescriptions filled at the UCSF outpatient pharmacy, pick them up, deliver them to the patient bedside, perform patient consultation and education, and close the loop on our medication reconciliation process. It was an effective system, especially for patients that were frequent flyers.
This is an oft-overlooked opportunity within healthcare systems, especially those that donâ€™t have a hundred fourth year pharmacy students running around the hospital. But that shouldnâ€™t stop facilities from engaging patients even if they have to bring in pharmacists from outside their system. They should look for community pharmacies in the area that would be willing to partner with their healthcare system to provide bedside medication delivery and consultation, thus beginning the process of building a working relationship between patient and pharmacist. As the patient moves from the hospital back into their daily routine they can continue to grow a relationship with the community pharmacies. The payoffs are huge, especially for those patients with chronic diseases like diabetes, asthma, hypertension, hypercholesterolemia, and so on.
Not all patients are willing or able to be compliant, but some are. Using Daveâ€™s number of $330 billion annually, a conservative positive impact of 10% cost avoidance is more than $30 billion a year. Not too shabby.