The Business Case for Better Medication Adherence
May 1, 2008
The Problem
Nonadherence to medication is a serious problem in the United States and around the world. The World Health Organization estimates that only 50% of patients take their medicine as prescribed for long-term therapy.1 In a survey of Americans in 2006, three out of four patients stated they do not take their medications as prescribed.2 Patients that are nonadherent most commonly omit doses of medication or do not consistently take the medication at the same time every day.3 The most common reason cited for nonadherence is forgetfullness.3 Other cited reasons include high copayments,4 a long lag between doctor appointments,5 lack of information about the proper way to take the medication,3 and side effects such as nausea, frequent urination, or loss of libido.
The Costs
Nonadherence to medications reduces the effectiveness of the medication, thus compromising patient health and safety.1 When patients do not take their medicines as prescribed, a myriad of health problems can ensue, such as disease progression, disease complications, and lower quality of life, to name a few.6 If the medication is an antibiotic, nonadherence may also lead to drug resistance. As a consequence, nonadherence leads to increased healthcare costs.1 For example, 33%-69% of medication-related hospital admissions in the United States are due to nonadherence.3 In total it is estimated that nonadherence costs the United States approximately $100 billion annually in total direct and indirect costs.7
Employer Solutions
- To gain a better understanding of employee nonadherence, it may be helpful for employers to conduct an employee survey on medication adherence or add questions on medication adherence to an existing health risk assessment (HRA). Questions to ask include:
- Do you take medication daily to manage a health condition?
- If so, does the medication require that you take it at the same time every day?
- Do you consistently take your medication at the same time?
- How often do you miss a dose of your medication?
- What is the primary reason that you miss a dose of medication?
- To improve medication adherence, it is important that employers recognize and remove any potential barriers, such as limited access to healthcare, restricted formularies, or high copayments.
- To help employees remember to take their medications, provide them with tip sheets with helpful reminder ideas (i.e. setting an alarm clock for the same time every day).8
- Doctor-patient communication is critical. In order to be fully adherent, patients must understand the importance of their medication, and when and how to take it. Employers should work with health plans to ensure that patients sign a statement at the end of a doctor's visit stating that they fully understand how to take the prescribed medication.8
- Not only must doctors provide clear directions on how to take medications, but patients must play an active role as well. To encourage engagement, employers may want to provide employees with information on questions to ask their doctor. The following link provides helpful information on how patients can successfully talk to their doctor: Quick Tips-When Talking to Your Doctor
Citations
- World Health Organization. Adherence to long-term therapies: evidence for action, 2003. Available at: http://www.emro.who.int/ncd/Publications/adherence_report.pdf. Accessed April 8, 2008.
- National Community Pharmacists Association. Take as directed: a prescription not followed. Research conducted by The Polling Company.TM December 2006.
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497.
- Kessler R C, Cantrell C R, Berglund P, Sokol MC. The effects of copayments on medication adherence during the first two years of prescription drug treatment. JOEM. 2007;49(6):597-609.
- McDonald H P, Garg A X, Haynes R B. Interventions to enhance patient adherence to medication prescriptions. JAMA. 2002;288(2).
- National Council on Patient Information and Education. Enhancing prescription medication adherence: a national action plan, 2007. Available at:
http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf. Accessed April 8, 2008.
- O'Connor PJ. Improving medication adherence Arch Intern Med. 2006;166:1802-1804.
- Medication Nonadherence. Drug Benefit Trends. 2005;17(7).
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