All the terrific treatment your organization provides to a patient may be for naught if that patient fails to adhere to the medication regimen determined by your clinicians. Non-adherence is associated with higher rates of suboptimal outcomes as well as increased admission and readmission rates, morbidity and mortality, and healthcare costs.
Unfortunately, statistics show that about half of all patients do not take their medications as prescribed. Adherence with a regimen that includes an incorrectly prescribed medication, such as a mistake about the type of drug, dosage, refill frequency, can also cause great harm to a patient. To improve medication adherence, and reap the benefits that come with it, organizations should strive to improve their medication management program.
Here are three worthwhile medication management goals to set for your organization.
1. Improve patient education
There are many reasons why so many patients fail to adhere to a regimen. Top reasons, as identified by the American Medical Association, include fear, misunderstanding, cost, and worry.
Patient education can go a long way toward overcoming these and other obstacles to adherence. Organizations should assess their current approaches to patient education about medications and adherence and determine ways to strengthen how information is provided to patients.
Education must speak to the importance of following a regimen and the risks of failing to do so. It should cover common side effects (so patients aren't surprised if they occur) and what patients should do if they experience common or uncommon side effects. It should provide helpful resources that can assist with overcoming cost challenges, filling and refilling prescriptions, and sticking to a schedule that can grow in complexity with the addition of new medications. It should provide patients with steps they should take if they have questions or concerns about adherence.
Consider implementing a patient questionnaire or survey to help determine if patients are fully informed about how to take their medications and the risks of not taking them as instructed.
While providing education cannot ensure a patient will adhere to a regimen, organizations should do all they can to help make adherence easier.
2. Reduce medication errors
By definition, all medication errors are preventable. And yet thousands of deaths every year are attributable to adverse drug events (ADEs).
Organizations should set a goal of zero medication errors and ADEs, including those associated with modifying patient regimens. While achieving this goal may seem unrealistic, any goal other than zero would suggest a willingness to accept some medication errors. With that said, another goal should be to reduce the number of medication errors month over month, quarter over quarter, year over year, always keeping that zero goal as motivation for improvement.
There are numerous processes organizations can put in place and technologies that can be used to help reduce medication errors. One of the most critical steps organizations should take is to perform a comprehensive root cause analysis every time a medication error and ADE occurs (another worthwhile goal).
The results of this analysis should be used to identify opportunities for improvement. Organizations should then implement changes and monitor and measure whether these changes are having the effects desired that will help prevent such a medication error from occurring again.
3. Strengthen follow-up processes
Medication management work doesn't stop after patients are discharged. Organizations should set a goal to ensure there is a follow-up plan in place for all patients and consider this an essential component of the discharge process.
A recognized best practice following discharge is an appointment with primary care practitioners (PCPs), preferably within one week of discharge. A Journal of Hospital Medicine study showed that "patients lacking timely PCP follow‐up were 10 times more likely to be readmitted for the same condition within 30 days of hospital discharge and nearly seven times as likely to be readmitted for the same condition or receive other care."
The follow-up appointment is vital for several reasons from a medication perspective. A PCP should review a patient's medication regimen and hopefully catch any signs and symptoms indicative of non-adherence. A PCP can serve as another source of education, further stressing the importance of adherence and answering questions patients may have about their new regimen now that they have been on it for a few days.
Asking patients to follow up with their PCP is well and good, but actions speak louder than words. Technologies are making it easier for organizations to schedule such follow-up appointments for patients, which will improve the likelihood of patients actually making it in to see their PCP in a timely manner.
Organizations should also set a goal to follow up directly with high-risk patients, such as those with chronic conditions (e.g., heart disease, diabetes, epilepsy) and elderly patients taking many different medications. Whether through a call, email, or use of an automated system that provides instructions, condition- and medication-specific questions, and/or information from their clinician(s), such proactive follow up can help identify regimen adherence issues early and keep patients on a road to recovery.