No Magic Pill for Prescription Non-adherence

Do you take your medications as you and your healthcare practitioner agreed to? Every day? Exactly as recommended? Surely, as people who work in and around healthcare, we take our medicine correctly—right?

In a recent study of 40,000 adults, Express Scripts Inc. found that more than 90 percent of respondents agreed that taking medications as prescribed was important, and 81 percent felt that skipping doses had negative consequences. And interestingly, when ranking healthy behaviors, respondents said taking medications as prescribed was more important than quitting smoking or eating a healthy diet.

So, why does the published literature report that on average, only 50 percent of patients are adherent with chronic medications, and roughly 60 percent are adherent with acute treatment regimens?

Medication non-adherence impacts us all, whether we are employers paying for healthcare, healthcare professionals treating patients, or as a patient among the almost 50 percent of Americans who have a chronic condition that can take a medication to improve their health. There is a large body of evidence that demonstrates serious negative outcomes and significant cost increases to the healthcare system associated with patients not taking their medications as prescribed.

The New England Healthcare Institute has estimated that non-adherence costs the United States $290 billion annually. Of course the obvious clinical consequence of not taking medications correctly is decreased treatment outcomes. But it also has been shown to increase hospitalizations and readmissions, increase nursing home admissions, and increase mortality, just to mention a few.

Medication adherence is a very complex issue. Despite the widespread knowledge of adherence rates being low, there has been no magic pill to cure the problem. The perfect storm is brewing for improving this critical determinant of health. Many of the provisions of PPACA, as well as other recent legislation and public health policies, have increased the focus on coordination of care and medication management. Improving adherence will be a critical success factor for organizations that are participating in some kind of accountable care initiative or a patient-centered medical home. Almost every organization focused on healthcare quality has measurements and recommendations around increasing adherence.

And this one is for those of you who above responded with yes to being an adherent patient … In a separate survey conducted by ESI, the average patient self-reported a 90 percent adherence rate, but when claims of those patients were reviewed, they had an average adherence rate of 24 percent.

While I try to remember if I took my thyroid medicine this morning, I would be interested in hearing how you are addressing the issue of medication non-adherence within your companies. And if you have not looked at this serious medical problem, I encourage you to consider it.

Dana McCormick is an area medical manager for the pharmaceutical company Sanofi. Contact her at dana.mccormick@sanofi.com.