More than 131 million adults in the United States – which amounts to 66% of people in the country – use prescription drugs. Even though so many people take prescription medication, around 50% of them don’t take them as prescribed. The healthcare system has a $300 billion dollar problem – medication non-adherence. While the damage to the patient’s health is evident, the cost to health plans often goes unseen. In fact, failure to take prescribed medications is responsible for 16% or $500 billion in healthcare spending every year, as those patients often need additional or emergency care or hospitalization. With the 5-Star rating system introduced by the Affordable Care Act, it’s never been more critical for health plans to modernize their medication adherence programs for both the health of their members–and their finances.
The traditional role of clinical pharmacists
The standard view of the role of a clinical pharmacist, especially for those not entrenched in healthcare, is simply as a medication expert who oversees accurately and effectively dispensing medication. This narrow view minimizes the role a clinical pharmacist can and should have in patient care and outcomes. While clinical pharmacists are tasked with dispensing prescriptions and medications, their role also includes advising and consulting with the primary care team on using pharmaceuticals in patient treatment; creating and developing drug care plans to complement other modalities; and managing, preparing, and dispensing medication. In short, the clinical pharmacist is a vital member of a patient’s care team when it comes to the role of medications in both acute and long-term care. When included in patient care teams and planning, research suggests the inclusion of a clinical pharmacist increases positive health outcomes.
The challenges of medication adherence
Intense focus has been placed on medication adherence over the last few years, and with good reason. The impact of non-adherence is significant – creating dangerous situations for patients and costing the healthcare system billions of dollars every year. However, part of the larger problem requires understanding the challenges faced by patients and care teams when it comes to ensuring adherence to prescribed medications. While frustrating, medication non-adherence often runs deeper than just resistance to a treatment plan. Patients may be non-adherent due to transportation difficulties in getting to the pharmacy, a lack of understanding of proper medication administration, or misunderstanding their medication and its uses. In one study, the average non-adherence rate across all diseases is roughly 25%, according to a meta-analysis of more than 500 studies. However, certain medications were more frequently associated with non-adherence than others. Non-adherence is highest in patients with arthritis, gastrointestinal disorders, and, most surprisingly, cancer. These illnesses and conditions pose significant threats to life and quality of life, suggesting we need a much better understanding of why patients make those choices. Some frequent challenges to medication adherence include:
- Poor communication between the treatment team and patient
- Access to or cost of medications
- Poorly educated patients/lack of information about treatment or condition
- Lack of acknowledgment of the impact of non-adherence to medication on negative outcomes/death
- Stigmas/fears related to specific medications
- Comorbidities that impact adherence to medication regimens
- Lack of trust between patient and provider
- Patient denial over the seriousness of an illness/condition
However, for many, fear of adverse side effects is the number one reason to avoid taking a prescribed medication. In a poll conducted by Health Dialog, people were asked to say which side effects would make them stop taking their medications. These are the results:
- 38% sudden weight gain
- 34% feeling of nausea
- 19% fatigue and dizziness
- 9% visible skin irritations
At the surface level, some might chalk up non-adherence to these simple fears. Often though, non-adherence is a compounded issue. For example, fear and misunderstanding are symptoms. The larger problem is the lack of proactive education, intervention, and a dedicated medication adherence program resource. Medication adherence, as a clinical goal, must factor in each of the potential challenges as we seek out more effective ways to ensure patients are able to not only access medications but to take them in the prescribed dosage at the right times.
Why medication adherence is important
A lack of proper adherence can hinder one’s ability to treat serious diseases. That, of course, leads to more medical complications down the line and lower life quality for the patient. The negative impact isn’t only on the patient. For health plans, lack of adherence leads to increased costs and poorer health outcomes – which ultimately leads to a dip in quality scores (HEDIS/Stars). Of the 40 key quality measures in the Medicare Stars rating system, 12 are prescription drug-specific. In addition, these factors have a weighting of 1x to 5x, making them a vital component for the overall plan rating. With Star Ratings bonus payments expected to exceed $2 billion for the large, public Managed Care Organizations (MCOs) in 2015 alone, adherence should be a top priority for MCOs. Let’s dive deeper into the impact on both patients and health plans.
Non-adherence impact on health
A patient’s inability to obtain and use medication appropriately limits the drug’s effectiveness. Non-adherence can lead to many unwanted side effects. One study discovered that seniors taking statin-reducing medications could increase the risk of dying of a heart attack by 25% if they suddenly quit them.
Non-adherence impact on mortality
Each year, more than 125,000 preventable deaths occur in the US due to medication non-adherence. These deaths could be easily avoided if healthcare professionals explained to the patients that dying from non-adherence to medication is ten times greater than dying from homicide.
Non-adherence healthcare system costs
As people age, the cost of medically managing their conditions grows. Financial experts estimate that between $100 and $300 billion in annual healthcare costs are easily avoidable. To put this into perspective, consider that these costs represent between 3% and 10% of the US total healthcare costs annually.
How clinical pharmacists impact medication adherence
Providing patients with enough information, keeping a blame-free environment, and delivering positive feedback for medication adherence is critical to a trusting provider-patient relationship. Because health is a very personal topic, addressing the issue of medication adherence needs to take a more personal approach. This is a role clinical pharmacists can step into quite easily for a variety of reasons. Understanding the scope of the problem and why so many people fail to follow simple instructions are essential first steps in solving this problem. The final step in preventing non-adherence is creating a system of accountability for the patient. And in many cases, this begins with the simple step of creating scheduled, pharmacist-led clinical consultations. For example, assessing medication-taking can be done through self-reporting. Studies show that some patients overestimate adherence by a staggering 200%. Simply by talking to the patient at scheduled intervals, one can learn a lot about their habits. These 1-to-1 long-term relationships enable pharmacists to understand which patients are at higher risk for non-adherence and employ tactics to limit lapses. Further, this regular contact and relationship-building increase trust and improve the likelihood of patients attending scheduled meetings with their providers. The patient needs to actually show up for a provider to educate their patient on what the medication does, how it helps them, and how much it improves the quality of their life. Here are a few strategies used by the Reliant Medical Group from Massachusetts to improve patient adherence to blood pressure medicine:
- Trying to help patients improve their health literacy on hypertension
- Pharmacist-led calls with patients about medication timing and dosing
- Giving their patients lower-cost, generic medication substitutions
- Pharmacist-led medication reconciliation and monitoring of medication treatment plan
One study found that patients with chronic diseases enrolled in an appointment-based medication synchronization program were 3.4 to 6.1 times more likely to be adherent than patients without synchronized medication refills. Note the critical role clinical pharmacists play in improving patient care, outcomes, and medication adherence. The Aspen RxHealth difference: patient-pharmacists relationships and medication adherence While we’ve noted several challenges above, the most significant barriers are frequently created when the relationship between patient and provider is seen as purely clinical or, worse, transactional. An effective, comprehensive medication management (CMM) program that utilizes clinical pharmacists can dramatically improve adherence and patient health through regimented chronic condition management, eliminate the fear of medication-related side effects through education, proactively identify medication adherence gaps, and drive appropriate interventions. However, there’s a difference between a qualified provider and the right provider. While there are a multitude of qualified providers out there, for many patients, the “right provider” means one matching patients to clinical pharmacists based on criteria like native language, geography, specialty, etc. These connections are essential, and research suggests that patients prefer providers who share demographics with them. There is also research to suggest that patient outcomes are improved and incidents of implicit bias decrease. In fact, in one study that focused on collecting large amounts of data on patient behavior, clinicians at Sichuan Provincial People’s Hospital successfully evaluated peoples’ adherence status. By recording demographics, disease, treatment, diet, exercise, and mental status information, researchers found that 21.2% of the patients were susceptible to poor adherence. While making this connection might seem overwhelming, healthcare technology companies, like Aspen RxHealth, already specialize in this sort of matchmaking. Non-adherence is one of the enormous costs and fatality drivers in healthcare today, but it also represents one of the biggest opportunities. Matching patients with the right provider is one of those opportunities. Through healthcare technology and accessibility to high-quality clinical pharmacists, the quality of resources available to implement effective medication adherence programs has never been higher. And that’s great news for patients and health plans alike. If you’re ready to talk about how Aspen RxHealth can help you transform the lives of your patients and your healthcare organizations, reach out to our team today, and let’s get started!