"Medical Noncompliance: The Most Ignored National Epidemic." That's the title of an article in The Journal of the American Osteopathic Association. It's also quite a claim, but the authors do an effective job of making their case. They note the numerous reasons why noncompliance — including medication noncompliance — is so devastating to patient health and wellness (as well as a significant financial burden on our health system) and why it affects so many patients. As the authors note, "...an epidemic is defined as affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time." This certainly seems to describe the impact of medical noncompliance.
The authors call on the medical community to step up, acknowledge medical noncompliance for the substantial challenge that it is, and start working to bring about improvements. If we fail to do so, turning a blind eye to noncompliance and accepting it simply as a given part of patient care, the authors note that "...we are not only allowing an ever-expanding epidemic to continue, but moving forward, we will be held financially responsible."
Fortunately, health systems and clinicians willing to take on this challenge do not need to begin tackling the issue unarmed. Rather, there are already many proven solutions and approaches they can consider implementing into a broader compliance improvement plan. In this blog, we will focus specifically on reducing drug-related noncompliance by sharing six ways to increase medication compliance — a few of which may surprise you.
1. Accept the reality of the challenge.
An essential first step in combatting medication noncompliance is accepting that this, in fact, is a challenge for your organization and your patients. An action plan for better medical compliance among patients described in The Journal of the American Osteopathic Association article includes the following advice: "Acknowledge that there is often a lack of patient understanding in regard to follow-up and medication treatment. Have your ancillary staff call your patient to see if he or she has questions that need to be answered."
2. Be cognizant of pill color and shape.
People are creatures of habit. Disrupt a working routine — even in seemingly harmless ways — and you may do greater harm than you realize
That's one of the takeaways of a study from the Annals of Internal Medicine that looked at the impact on medication compliance of changing the color and shape of a drug — in this case generic drugs for patients with cardiovascular disease after myocardial infarction. About 29% of the nearly 12,000 patients in the study had pills changed in color and shape during the study. The odds of medication nonresistance (i.e., interrupted medication use, thus medication noncompliance) increased by 34% after a change in pill color and 66% after a change in pill shape. When considering revising a patient's medication regimen, take visual changes into account to the best of your ability.
3. Consider the use of comic books.
In a previous blog, we explained the value of using educational handouts to improve medication compliance. Among the advice we shared was to keep such handouts simple because of challenges associated with health literacy. We wrote, "The simpler, the better—and the more likely patients will read the handout and follow through with the instructions."
What if instructions were provided in comic book format? A Hong Kong study published in Global Health Promotion aimed to investigate the effect of verbal advice and comic books on health literacy and medication compliance among older adults. Researches reported that the use of comic books delivered noteworthy improvements in health literacy, medication compliance, reduced knowledge deficiency, and reduced storage problems.
4. Reward compliance.
One would hope that the safety and health benefits of medication compliance alone would be enough to encourage people to remain compliant. And yet statistics show that's not always the case. A powerful motivator, according to an Express Scripts survey? Rewards.
As a HealthLeaders report notes, he survey revealed that healthy majorities of people with chronic diseases want just that for taking their medications. The article states, “Two-thirds of the 800 chronically ill adults polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts. Those numbers vaulted to 88% for adults ages 18-34.”
The article goes on to spotlight the Mango Health app, which rewards users for documenting when they take a medication. Mango Health was one of the apps we highlighted in a recent blog.
Another innovative approach to medication compliance is being undertaken by Wellth, a health IT company based in Brooklyn, N.Y. The company uses a creative combination of behavioral economics and technology to achieve better adherence, engagement, and health. Wellth's approach uses intrinsic and extrinsic motivators to change patient behaviors.
Clinicians looking for an app of their own to help improve their patients' medication compliance should consider Cureatr's Meds 360°. While Meds 360° may not reward clinicians for its use, the solution will provide many tangible benefits.
5. Leveraging texting.
Your organization is likely already using one or more phone calls, mailed letters, and emails to communicate with patients about their medication regimen and importance of compliance. But what about texting? It's a platform strongly worth considering if you're looking for ways to increase medication compliance.
Consider that about one in three patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed, notes a PLOS One study. Text message reminders were shown to reduce the number of noncompliant patients to under 10%. Another study published in Applied Clinical Informatics demonstrated that text reminders can improve medication compliance for individuals with sickle cell disease.
HIPAA-compliant texting has become a commodity in healthcare, and more solutions exist than ever before to connect providers and patients, such as Cureatr's secure messaging application.
6. Use fixed-dose combinations
A fixed-dose combination (FDC) medication combines two or more drugs contained into single dosage form. As AIDSinfo notes, an example of an FDC HIV drug is Atripla, which combines three medications: efavirenz, emtricitabine, and tenofovir disoproxil fumarate.
When clinicians can reduce the number of medications patients need to take and manage, they reduce the opportunity for the many types of errors that can contribute to medication noncompliance. As multiple studies have shown, including this meta-analysis, "FDC's decrease the risk of medication noncompliance and should be considered as a means of increasing medication compliance in patients with chronic conditions."