Taking your prescription and over-the-counter medications faithfully will help you stay healthier, live longer, be more productive, and reduce cost. Former U. S. Surgeon General C. Everett Koop stated the obvious: “Drugs don’t work in people who don’t use them.” There are 3 billion prescriptions written each year but only about 50% are taken correctly. With only about half of all people for whom medications are prescribed adhering to the regimens, more than one hundred billion dollars is spent each year on avoidable hospitalizations—according to a New England Journal of Medicine article. An estimated 89,000 premature deaths from high blood pressure could be avoided if patients took their anti-hypertensive medicines faithfully.
Common reasons for not taking medications include cost, regimen complexity, lack of coordination among caregivers, psychological issues, health literacy, poor support systems, side effects and the fact that many patients do not understand why they were prescribed the medication in the first place.
Examining the cost involved, out-of-pocket expenses for medications clearly affect adherence; a larger percentage of people take more drugs when prices are lower. However, even with health plans where there are no out-of-pocket costs for medications, the compliance is only about 10% better, or 60+% of patients who stick with their prescribed medications.
Typically, patients over the age of 65 take four times more medications and have four times more illnesses than younger folks. Regimen complexity contributes to non-adherence when physicians are unaware of other medications prescribed by colleagues. Every prescriber is focused on their disease process they are treating, often resulting in redundancy, side effects or other untoward consequences.
Behavioral, social, financial, and medical stresses would be ameliorated, according to former surgeon general, Dr. Joycelyn Elders, “if patients were given a better understanding of why they should take their drugs and the repercussions of stopping.” Education is key, as simple as a nurse coaching the patient on how to take a particular medication or a pharmacist reinforcing the reasons for taking a specific drug. It must be a patient-centered approach.”
Changes in health care delivery—the use of information technology, reducing co-payments, coordinating care and, most importantly, identifying patients who are most likely not to be compliant—will go a long way in accomplishing improved adherence.
Computers are everywhere. Having a digital reminder from your handheld device would be an easy first step to have patients take their medications on time. An electronic medical record would encourage sharing of information among providers, enabling those in the healthcare field access to all prescribed medications, lab data and the patient’s medical history. Side effects and the interaction of drugs could be anticipated electronically, as computer algorithms monitor in the background.
Making medications more affordable so that compliance improves ultimately saves money for everyone—patients, insurers, and providers. Rather than charging a co-payment for a medication, having an economic reward, namely being paid for following instructions and healthy behavior would improve outcomes. Programs like this have been successful in France and other countries.
Coordinating care to reward caregivers for positive outcome—rather than the current “fee-for-service” methodology which rewards for more volume, e.g., more visits—will encourage physicians and nurses to educate patients regarding their medicines. Recent shifts towards paying for integrated health care, which is like a “one stop shop” for patients, has also resulted in improved compliance and satisfaction.
Treatment guidelines for various chronic diseases have been shown to lengthen lifespan and decrease morbidity (complications). A patient’s proclivity in adhering to treatment plans is being studied currently with comparative effectiveness research. Already, certain non-compliant patients can be identified and coached to take their medications, follow their diets, and generally do better.
We know we have a challenge with healthcare costs and outcomes. Our very advanced medical care works best when a patient follows instructions. The next simple, inexpensive, and correct step is to increase our medication compliance rate from the current 50% to as close to 100% as possible. We should not be spending more... we should be spending smarter.
