Despite the potential for adverse health effects, about 50% of patients don’t take their medications as prescribed, according to the Centers for Disease Control and Prevention (CDC). Southwestern Health Resources wants to close these care gaps by focusing on ways to help patients adhere to medications.
Major consequences of not taking medicine as prescribed may include the progression of disease, hospitalization and even death. In spite of these risks, patients can experience multiple barriers to medication adherence.
For example, financial concerns may cause patients to skip or ration doses by taking half of what the doctor prescribes. Other times, patients forget to consistently take the medication or they discontinue due to unpleasant side effects of the prescription.
When a condition like hypertension is mild, there aren’t any symptoms, so patients may assume they don’t need medication. “They might not realize the importance of medication in preventing more serious disease like kidney disease or stroke,” says Amy Flowers, SWHR Senior Director of Value-Based Pharmacy.
One starting point to medication adherence is education.
“There’s a higher likelihood that patients will take their medication when they fully understand why they are taking it,” says Yvonne Ochieng, SWHR Population Health Pharmacy Program Manager.
How is medication adherence measured for Medicare STAR ratings?
As part of their Quality Measures, the Centers for Medicare and Medicaid Services (CMS) uses a methodology called “Proportion of Days Covered” (PDC) to calculate a member’s adherence to their prescriptions. This is reflected as a percentage of days a member has prescription medications on hand as measured by the prescription insurance claim.
The goal established by CMS is 80% adherence to medication, considered the lowest threshold for medication therapy to be effective.
Steps for improving adherence
One method shown to improve adherence is prescribing a 90-day instead of 30-day supply of a prescription, ensuring patients won’t have to visit the pharmacy as frequently. When automatic refills are scheduled with the pharmacy, this helps ensure patients have the medications on hand.
SWHR uses data to determine which patients are late for refills and falling non-adherent. Using this targeted list, SWHR reaches out to patients to provide reminders and assess if they have issues or concerns with getting their medications refilled. Addressing issues may require tools or tricks like using a pill box or a smart phone to set reminders. For those taking many medications, SWHR asks if the patient has a caregiver to help assist with management.
“When a patient is complaining that, for example, their cholesterol medication is causing their muscles to hurt, we always reach out to the provider to make them aware so they can follow up with the patient,” Ochieng says. “The provider will often call and thank us.”
When costs are a barrier, the first question is whether a less expensive generic is available. If there isn’t a generic version, an SWHR Social Worker helps the patient see if they are eligible for a prescription assistance program. When transportation to the pharmacy is a concern, SWHR will suggest a pharmacy home delivery or mail order.
Sometimes the insurance claim will incorrectly state that a patient isn’t adhering to medications because the doctor has changed the dosage but hasn’t written and filed a new prescription. SWHR works to ensure that the correct information from the provider is noted in the claims.
Medication non-adherence leads to 125,000 deaths and up to 25% of hospitalizations each year in the United States.1 About $100 to $300 billion in healthcare costs could be curtailed annually by addressing medication adherence.2
When a patient’s lab values identify disease progression, the natural inclination is to assume the medication isn’t working, so a provider may increase the dose or prescribe a stronger medication, Flowers says. But since medication non-adherence is so high, the provider should start with whether they are taking the medication as prescribed before increasing a dose or switching to a more costly brand name drug.
“For a patient to be honest about not taking a medication, we have to be empathetic when approaching the conversation by acknowledging that with a lot of medications and conditions, it’s hard to keep things straight.” Flowers says. “You create a trusting environment where the patient is honest so you know the next steps are the right steps.”
Sources:
1DiMatteo MR, Giordani PJ, Lepper HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794-811.
2American College of Preventive Medicine. Medication Adherence Clinical Reference. 2011. www.acpm.org/?MedAdherTT_ClinRef. Accessed June 10, 2017.
