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What Experts Are Saying: The Challenges of Medication Adherence

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We've had a lot to say about medication adherence over the years. So much, in fact, that we created a comprehensive guide for providers on medication adherence. Helping healthcare organizations and patients improve medication adherence is a significant focus for Cureatr. We know that when patients take their medication as directed, the health system experiences improve health outcomes and quality, reductions in admissions and readmissions, cost savings, and patient satisfaction.

We also know that about half of all medications are taken incorrectly, particularly regarding timing, dosage, frequency, and duration. Unfortunately, there are many factors that contribute to this high rate of medication non-adherence — factors that we take into careful consideration when developing solutions and providing services.

What challenges are associated with medication adherence? Here are 10 quotes from medication adherence experts.

1. Fred Kleinsinger, MD, in The Permanente Journal: "… unlike better-known causes of death such as heart attack or cancer, medication nonadherence is usually invisible to patients, their families, and the medical profession. It does not appear on the death certificate of a patient who has died of a myocardial infarction after not taking his antihypertensive medication or an antiplatelet agent to protect his stent. It is an orphan problem. To my knowledge, no major entity, organization, or group has taken it on as a priority. This topic does not fit into the boundaries of any one discipline. Insurers and health plans have other priorities, and few have addressed this problem in a systematic manner."

2. Catherine Misquitta, PharmD, MBA, BCPS, BCGP, FCSHP, in Pharmacy Times: "Medication nonadherence takes a significant toll on population health, but much of the problem lies in patients' limitations to access and understand the right treatment and medication information. Pharmacists can help improve medication adherence by communicating with patients to fully understand their needs and empower them to take control, sharing available options that could make adherence easier, and educating around the instructions and importance of following their treatment plans."

3. Denise Bentley, PharmD, BCPS, and Jacob W. Potts, PharmD, on the Fresenius Medical Care website: "Poor patient-provider communication has been identified as a main source of medication non-adherence. In a study of patients with chronic kidney disease, researchers found that patients omitted medications that they considered "less important," and a substantial divide existed between patients' beliefs about medications and generally accepted medical opinion. … Lack of provider empathy or frequent use of medical terminology may inhibit a patient from developing trust and may cause apprehension in seeking resolution to medication-related questions and concerns. Significant influences on non-adherence that are related to the health system include high co-pays or cost of medication, insurance formulary restrictions, and a structure of preferred and non-preferred pharmacies that may restrict prescription access. These healthcare system barriers may prevent prescription fulfillment, often without involving the provider to prescribe an alternative."

4. Alina Gast and Tim Mathes in Systematic Reviews: "Adherence is a multifactorial phenomenon that can be influenced by various factors. These factors can be divided into five different dimensions: social and economic factors, therapy-related factors, disease-related factors, patient-related factors, and healthcare system-related factors. Some factors can have an influence on intentional non-adherence (conscious decision not to take the medication; e.g., because of high co-payments), while others can have an influence on non-intentional (forgetting) non-adherence (e.g., forgetfulness because of mental comorbidity)."

5. Michel Burnier in Frontiers in Pharmacology: "To maintain a high level of medication adherence over years is one the most difficult challenge in the management of medical conditions, which need chronic ambulatory pharmacotherapies. This issue is even more relevant in asymptomatic conditions such as the treatment of cardiovascular risk factors. Indeed, in patients with hypertension or dyslipidaemia, non-adherence to medications is highly prevalent. This is certainly one reason why many patients with a high cardiovascular risk do not benefit from otherwise effective medicines."

6. Marie Brown, MD, to the American Medical Association: "Too often our reaction [to nonadherence] encourages the patient to conceal their nonadherence, and when that happens, it is very dangerous because the physician will think the blood pressure is resistant or their diabetes requires an additional medicine. As a result, the patient may be prescribed second and third meds when they are not taking the full dose of the first medicine. If adherence suddenly improves, for example upon hospital admission, blood pressure and glucose levels could drop precipitously."

7. Karthik W. Rohatgi et al. in the Journal of the American Board of Family Medicine: "Many people with low income are unable to adhere to medication regimens, and they also face difficulties in meeting basic needs such as food, clothing, housing, and transportation. Previous studies have found that inability to meet basic needs is associated with lower medication adherence. Several reasons may explain this association: Some individuals have no money for either basic necessities or medication; others with slightly greater means may spend less on medication in an attempt to meet food needs. Conversely, other patients spend less on basic needs to afford medications. Individuals spending less on basic needs to afford medications were more likely to have a greater number of prescriptions and greater out-of-pocket medication costs. Spending less on basic needs is also associated with a lower likelihood of actual medication adherence."

8. Lisa Cillessen, PharmD, to Pharmacy Today: "A lot of patients just simply don't pick up their medications because of the cost, and even if they are able to pick them up, they stretch them out. … Sometimes, patients come in to pick up four or five medications, and they can't afford that cost, so they just leave the prescription at the pharmacy. Or maybe they're taking half tablets [instead of the whole tablet] to make sure they do not run out of their medication."

9. Lisa Roome-Rago to PatientEngagementHIT: "Patients who are not following their treatment plan oftentimes get labeled as non-compliant. Our job is to better understand that. … People don't wake up in the morning and think 'I'm not going to follow what my doctor told me to do today.' It's a matter of figuring out what's actually going on and then trying to create a plan around that and minimize as many barriers as you can."

10. Jennifer K. Bussell, MD, FACP, to the National Institute of Diabetes and Digestive and Kidney Diseases: "We should not expect perfection. Providers need to recognize that medication adherence is a tough thing to discover. Some patients are stating that they're honest about their medication-taking behavior; however, providers need to recognize that there's a 'white-coat adherence.' Patients may be adherent a week or a month before they come to your office, so they can honestly say, 'Yes, I'm taking my medication as prescribed."

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