There is plenty of supporting published evidence showing that medication non-adherence has severe consequences for the patient’s health and results in billions of dollars in excess healthcare costs annually.
The World Health Organization defines medication adherence as “the degree to which the person’s prescription-related behavior corresponds with the agreed recommendations from the healthcare providers.” It is important to note that adherence definition involves social and behavioral aspects of patient willingness, resources and ability to take medications as instructed and agreed upon.
Physicians have long recognized that multiple factors will lead a patient to become non-adherent.
For example, a patient who cannot afford medications will not be adherent. A patient who forgets to fill their refills, or has difficulty getting to the pharmacy, will not be adherent. A patient who doesn’t understand the medication — or doesn’t believe it is necessary — will not be adherent.
These very real barriers exist among our patients, and yet our healthcare systems have struggled to mitigate them.
However, that is changing. With today’s focus on value-based care, there is greater awareness and supporting research of the impact of medication non-adherence. The need to address these barriers has become a top priority for most healthcare organizations.
Statistics to Define the Problem
There is a saying, “What gets measured, gets done.” Medication adherence is now being more closely measured, which has resulted in healthcare systems investing more resources in understanding and improving medication adherence.
Statistics show that overall, 50% of patients with chronic conditions are non-adherent. Even worse, for those with chronic illnesses that have longer asymptomatic periods, like hypertension or hyperlipidemia, there are reports of even higher rates of non-adherence.
It is estimated that medication non-adherence for patients with chronic conditions in US causes nearly 125,000 deaths annually, along with a 10% increase in hospitalizations. The excess healthcare costs associated with medication non-adherence are estimated to add up to $100 to $200 billion per year, with some estimates closer to $400 billion per year — all potentially avoidable expenses due to medication non-adherence.
Clearly, there is a critical need to understand the barriers that exist that lead to medication non-adherence. Data is available to support those initiatives.
Addressing the Barriers and Solutions
The reasons for non-adherence have been attributed to a variety of factors, and many solutions have been implemented in an attempt to improve adherence rates, some more successful than others.
- When patients have forgotten to refill their prescriptions, we have seen pharmacies come up with reminder systems and automatic refill options.
- Negative side effects that patients cannot tolerate can lead patients to skip or discontinue the use of the medication. This is important, and needs to be addressed with the physician so any side effects can be managed.
- Lack of drug insurance coverage, costly medications, and formulary tiers affecting the patient’s ability to get medications at lower and affordable prices.
- Condition-related factors, like patients’ mental or physical capabilities, may impact a patient’s ability to take medications as directed.
However, the barriers that patients face go much deeper. Where a person is born, grows up, lives, and works, known as social determinants of health, is believed to impact up to 50% of health outcomes.
These social determinants of health may help indicate some of these deeper barriers which include:
- financial instability,
- health literacy,
- lack of transportation,
- lack of local resources (medical providers, grocery stores),
- lack of neighborhood safety,
- lack of social support and network,
For example, a patient who has been prescribed a medication that is unaffordable or isn’t easily accessible – or they are uncertain of how to properly take the medication — is likely to be non-adherent, which can cause serious negative healthcare outcomes, rapid disease progression, more hospitalizations, and increased number of avoidable emergency room visits. At-risk patients often face more than one social determinant of health barrier so it is important to look at their situation holistically to address those of highest concern to improve their health outcomes.
There are interventions already in place that address some of these barriers:
- Patients who have economic instability may benefit from financial assistance programs, food delivery initiatives, free transportation for healthcare needs and other social services.
- Patients living in areas with high burglary rates are less likely to be adherent when it’s not safe to go to the pharmacy. They may need medications delivered to them or provided at the doctor’s office.
- Patients without relatives or associates living within close proximity may lack social support. They may need a pharmacy staff member to check in with them to see if they need help getting their medications or even understanding how to take them.
Evidence shows that these types of efforts are working because medication adherence has generally improved since 2016, as reported in the most recent Centers for Medicare and Medicaid Services Star Ratings Measure Trends Report.
Predictive Models Can Improve Medication Adherence
Using the insights and data elements derived from social determinants of health, alone or in addition to legacy healthcare data, has proven to be useful in predicting who is likely to face medication adherence challenges. Predictive models have been developed that align very closely with actual adherence rates, thus suggesting that SDOH are significant, if not one of the most important factors affecting medication adherence today.
This capability to predict patients who are facing the most challenges in meeting proper medication adherence rates should be the leading factor in proactively addressing and mitigating the key negative factors impacting their ability to become fully adherent.
The Best Course of Action
In my opinion, the best approach is to address two key factors:
First, focus on the social determinants of health and keep developing interventions to mitigate barriers that prevent patients from keeping up with their medication regimens.
Second, we as a society need to find ways to reduce prescription drug costs and overall healthcare costs in the United States which are sadly soaring. This could significantly improve adherence rates and, consequently, lead to improved healthcare outcomes, achieving the end goal of improved quality of life for all.
