What do suboptimal outcomes, higher rates of hospital admissions, increased morbidity and mortality, and rising healthcare costs all have in common? They're associated with medication adherence shortcomings. In fact, as the Centers for Disease Control and Prevention (CDC) notes, medication nonadherence is rampant.
In the United States, while about 4 billion prescriptions are written annually, roughly one in five new prescriptions are never filled. For those filled, only about half are taken correctly.
So, what is medication adherence, why is it so challenging, and what are ways clinicians can improve their patients' medication adherence? This blog will help answer these questions.
Defining Medication Adherence
To gain a better understanding of medication adherence, let's review how a few organizations, associations, and publications define the term.
The U.S. Food and Drug Administration (FDA) states,
"Medication adherence, or taking medications correctly, is generally defined as the extent to which patients take medication as prescribed by their doctors. This involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions."
The American Medical Association says,
"A patient is considered adherent if they take 80% of their prescribed medicine(s). If patients take less than 80% of their prescribed medication(s), they are considered nonadherent."
Prescriptions for a Healthy America states,
"Medication adherence occurs when a patient takes their medications according to the prescribed dosage, time, frequency, and direction."
The American Pharmacists Association says medication adherence is "… the extent to which a patient's behavior (e.g., taking medications with respect to timing, dosage, and frequency) corresponds with agreed-upon recommendations from a healthcare provider."
Finally, Pharmacy Times says medication adherence is "… the extent to which patients take medications as prescribed by their providers and agreed upon in the treatment plan."
Note: When defining medication adherence, it is essential to distinguish the term from medication compliance. Read this comparison of medication adherence and medication compliance.
Medication Adherence Challenges
Unfortunately, there are several barriers to achieving medication adherence, which all contribute to the alarming outcomes and statistics shared at the beginning of this blog. Here are four of the most significant challenges:
1. Ability to pay for medications
An ABC News report from April, citing the results of a survey by Gallup and West Health, noted that "Americans borrowed $88 billion to pay for healthcare in the past 12 months." Furthermore, the survey indicated that "… 15 million Americans deferred purchasing prescription drugs due to the costs of the medications."
Even more recent, data published in JAMA Open Network found that high-deductible health plans, which are common for employers, are creating substantial difficulty for patients to maintain adherence.
2. Low health literacy
The Center for Health Care Strategies states that "Nearly 36% of adults in the United States have low health literacy," with health literacy defined as "… the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
Limited health literacy is associated with medication nonadherence (in addition to a slew of other wellness and financial challenges). When patients are unable to grasp critical concepts, such as how to fill a medication, how to take a medication, when to take a medication, how much of a medication to take, and when and how to refill a medication, achieving and then maintaining adherence becomes very difficult, if not impossible.
3. Side effects
When patients experience adverse side effects from taking medications, they are more inclined to stop taking medications or try to adjust their regimen on their own to counter the effects. There are many different effects likely to contribute to nonadherence. A poll conducted by Health Dialog found that weight gain, nausea/upset stomach, dizziness/fatigue, and skin irritation were all examples of such negative side effects.
Patients taking at least five medications — typically referred to as polypharmacy — face several challenges directly linked to this high number of prescriptions. These include the complex dosing schedule, instruction confusion, multiple side effects, and greater expenses. To learn about these and other obstacles, read our blog discussing polypharmacy challenges.
Improving Medication Adherence
The good news for clinicians is that there are steps they can take to achieve improvements in patient medication adherence. An essential step is to take the time to understand the causes of nonadherence, such as those discussed above. Learning about these causes will help clinicians better identify when such causes are likely to contribute to nonadherence.
Providing education to patients is also vital. When patients better understand issues such as the importance of following a medication regimen and risks of deviating from it, how to respond to undesirable side effects, what to do if they encounter obstacles to adherence (e.g., affording medications, filling and refilling prescriptions), and how to get questions concerning their medications answered in a timely manner, adherence will improve. As a Patient Preference and Adherence study assessing the influence of different modes of patient education on medication adherence in patients with rheumatoid arthritis stated in its conclusion, "Patient education significantly improves adherence."
Considering the significant role that cost can play in contributing to nonadherence, clinicians should know how to help patients overcome this obstacle. As we noted in a blog on patient medication management,
"Cost must always be a topic covered by clinicians when discussing mediation regimens with patients. … In addition, clinicians must be prepared to provide resources to help patients reduce their medication costs. Such resources can include information on how to obtain financial assistance, safely order medications by mail, and identify and use a preferred pharmacy."
One company that is making an impact in this area is GoodRx, which we featured in Our Favorite Healthcare Mobile Apps of 2019 post. GoodRx has been making headlines for its prescription discount app. The company reports that the app has saved 10 million-plus consumers more than $14 billion since 2011.
Finally, clinicians should explore the availability of tools and technology that can assist them in helping their patients maintain adherence. One such example is Cureatr's solution, the Meds 360° technology platform. By providing clinicians with access to real-time prescribing and pharmacy pick-up information, they gain the ability to identify potential medication avoidance behaviors and then address these issues before nonadherence takes a significant toll on a patient's wellbeing. Meds 360° is a resource clinicians and organizations nationwide are finding invaluable in their efforts to provide safe, high-quality care that also contributes to cost reduction and better achieves the objectives of value-based healthcare.