Jerry Fahrni

Medication non-adherence, is more technology the proper response?

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Jerry Fahrni

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EMR & EHR: “Of all the things that irrationally inflate health costs, one of the top concerns is people who just don’t take their prescribed medications. Medication adherence doesn’t sound like a high-tech issue, but a lot of interesting technologies are being thrown at the problem…. At the recent Connected Health Conference I talked to several companies taking on the difficult adherence problem from different angles. Medisafe aids patients in self-monitoring, Insightfil creates convenient packaging that groups pills the ways patients take them, and Dose doles out medication at prescribed times.”  – The author goes on to describe some of the technology. The content is worth a few minutes of your time.

Here’s the thing, technology may not be the solution.

 

There’s no question that medication adherence is a problem. How big is the 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,  adherence rates are less than 50%. The New England Healthcare Institute NEHI in 2009 [PDF] estimated that the cost of non-adherence was about $290 billion annually. It’s probably well over $300 billion now, but the number I see in most presentations is $290 billion. Hey, it’s a good, scary number.

Medication adherence, or non-adherence as the case may be, not only complicates things for patients but for the entire healthcare system.

The problem is well defined, i.e. people aren’t taking their medications properly, but the solution has eluded healthcare for a long time. That’s likely because the reasons for non-adherence vary widely and have been debated and discussed as long as I’ve been a pharmacist. Have we made progress? It’s hard to say. I suppose it all depends on your definition of progress. We have lots of medication adherence tools at our disposal; reminder systems, mobile applications, smart medication organizers, alert systems for medication bottles, and so on. I suppose that could be considered progress.

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, and demographics.

However, one thing that people seem to overlook is that the contact point for most patients and their medications is a pharmacist. According to a recent report published by the National Community Pharmacy Association (NCPA), “the biggest predictor of medication adherence was patients’ personal connection (or lack thereof) with a pharmacist or pharmacy staff.”

A patient’s introduction to medication use should begin by developing a relationship with a pharmacist at the point of care, whether that’s a hospital or a community pharmacy. In hospitals, patients should speak with a pharmacist upon admission, and again upon discharge. No patient should ever leave the hospital without speaking to a pharmacist or without medications in hand.

This is an oft-overlooked opportunity within healthcare systems. For hospitals that don’t have the resources to speak with every incoming and outgoing patient, look to your local community pharmacies. Find community pharmacies in the area that are willing to partner with the 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, the relationship with their pharmacist will continue to grow. 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, and those are the ones we hope to reach. Using a cost for non-adherence of $300 billion annually, a conservative positive impact of 10% could add up to more than #30 billion a year in savings, not to mention the positive impact on a patient’s quality of life.

Bottom line, get a pharmacist involved early and often. Medication adherence, it’s what we do.

Comments

One response to “Medication non-adherence, is more technology the proper response?”

  1. Rayburn B Vrabel, PharmD

    RE: …get a pharmacist involved early and often. I agree with you 100%, but then again I’m a pharmacist too.

    Unfortunately, when I go into my local chain drug store to pick up a new prescription, I can “see” the pharmacist behind the glass wall, but I’ve never had one say one word to me. At the time of picking up my new prescription for a medication that I’ve never taken before, all I get from the pharmacy clerk is the comment, “Check this box if you don’t want to talk with a pharmacist”. There is NO offer from the pharmacist to counsel me about my new medications.

    Now, in my case it doesn’t matter. I am a pharmacist, but the folks at the chain drug store do not know that. But, what about other patients who could actually benefit from talking with a pharmacist? This is NOT the way to encourage open dialog between the patient and the pharmacist.

    The chain drug stores probably condone the behavior I observe in my local pharmacy. They want to keep the pharmacist productive checking prescriptions. More prescriptions, more revenue. Then again, if pharmacists actually talked with patients about the importance of taking their medications, the patient may actually take more of their medications (i.e., adherence) and this would also result in more prescription refills. If the chain store management figured this out, they might figure it out that they could make even more revenue this way. Oh, and the patient might benefit too…

    There I go day dreaming again…

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