So Many Medications, So Little Adherence

By Renee Brown, RPh / MBA/ Business Development – C3HealthcareRx

If you are reading this article, chances are you take at least 1 medication daily, or at least know someone who does.

With 51% of Americans being on chronic medication, medication non-adherence has become an epidemic. In an article published by Pharmacy Choice, it is reported that an estimated 125,000 deaths per year are attributed to poor medication adherence, and total healthcare spending for patients with poor adherence are almost twice that of patients with high adherence.

But Why?

There are numerous studies, providing various reasons for medication non-adherence. To get an idea of the what affects many patients, let’s look at Mrs. Jane Doe.

Multiple Medication Therapies & Confusion. Mrs. Jane Doe visits her primary care physician, Dr. Primary, and upon noticing her high blood pressure is prescribed Hydrochlorothiazide 25mg. A few weeks later Mrs. Jane Doe visits her cardiologist, Dr. Heart and is prescribed Lisinopril and Hydrochlorothiazide 20mg/25mg. To be sure, Dr. Heart DID mention that he was discontinuing the hydrochlorothiazide, however as Mrs. Jane Doe leaves the office, uses the restroom, and gets situated in her car, she quickly forgets her doctors order to discontinue the medication.

Patients remember as little as a fifth of information discussed and immediately forget 40%‐80% of the content of their medical encounters. When patients are taking multiple medication, and have multiple physicians, the risk for medication non-adherence increases dramatically.

Patients also need to see the value of taking their medication. Why its prescribed, what it does, what happens if it’s not taken.

Side Effects & ADEs. Upon leaving her cardiologist, Mrs. Jane Doe gets her new prescription filled at her local grocery store and enjoys a nice afternoon of grocery shopping. The next morning, she takes her Hydrochlorothiazide 25mg, as prescribed by Dr. Primary and her Lisinopril/Hydrochlorothiazide 20/25mg as prescribed by Dr. Heart, still not remembering that Dr. Heart discontinued the hydrochlorothiazide. While visiting her daughter 2 hours away, Mrs. Jane Doe later alerts her daughter that she’s feeling light headed, and promptly faints. Her daughter quickly calls 911, and Mrs. Jane Doe is admitted to the hospital.

1 in 5 Medicare patients are readmitted to the hospital within 30 days. Half of them are a result of non-adherence.

Transportation & Polypharmacy. Upon discharge, Mrs. Jane Doe is prescribed Metoprolol tartrate 25mg. Her daughter drives her to the drug store next door, and Mrs. Doe has the new prescription filled. Although she has the medication filled, due to fear of another adverse reaction Mrs. Doe does not consistently take her new prescription.

For patients relying on others, limited transportation delayed refills. Patients may also experience polypharmacy leading to unidentified contraindications or duplicate therapies.

So, What’s the solution?

While there is no silver bullet for fixing medication non-adherence, there are different approaches that can help increase adherence.

Complex medication regimens are like ticking time bombs. It’s so easy for a patient to mix up a medication, fill a pill box incorrectly, take a medication at the wrong time of day, or accidentally take a medication twice. Several pharmacies have utilized compliance packaging in the form of weekly boxes, blister packs, or medication packets to address this.

The pharmacy times reports that in the STOMPP study, patients who received multi-med blister cards achieved adherence scores greater than 45% above baseline when compared to pill bottles.

As with all relationships in life, communication is key. Increasing medication adherence, involves a patient’s entire circle of care. Their providers, their pharmacy, their caregivers.

In a study published by the Journal of the American Pharmacists Association, it was found that pharmacists and physicians revealed a clear desire for collaboration. They recognized that they were taking care of the same patients and that identifying strategies was a starting point for both improving their patients' care and improving their work efficiencies -- a “win-win situation” for everyone.

In addition, pharmacies across the country have utilized medication delivery and/or synchronization. This approach not only decreases the confusion of receiving multiple medications at varying times of the month but eliminates the need to rely on others for transportation.

In a recent study by Harvard Medical School, patients enrolled in a medication synchronization program had 9% lower rates of hospitalizations and emergency department visits compared to those not enrolled, likely due to the associated improved adherence.

What Can You Do?

Payors. Expand access to synchronized prescription drug refills.

Humana, which helped facilitate research on synchronized refills, found that beneficiaries with traditionally low adherence can increase their adherence rates by 25 percent through synchronized refills

ACOs. Do you have a waivered pharmacy?

Pharmacists can provide preventative care, Medication Therapy Managements and, gather vital data that may not be gathered within the hospital or provider’s office, and assist in providing patients with smooth transitions of care from the hospital to their homes.

Providers. Work with your local pharmacists and inform patients of pharmacies that provided a greater level of care.

C3 HealthcareRx, for instance partners with Payers, ACOs and Providers to better care, increase collaboration, and increase compliance. C3 provides medication delivery, medication synchronization, as well as compliance packaging at no additional charge to patients. Working with Payers, ACO’s & Providers, C3 also provides in-home visits, telehealth, and a mental health platform to further increase medication adherence and improve overall health outcomes.

So as the population ages, medication non-adherence will continue to be a challenge we must face. However, there are steps that can be taken to make this challenge a little less daunting. Why not see what you can do to make the change for the lives you touch.

[i]http://www.nbcnews.com/id/24603120/ns/health-health_care/t/more-half-americans-chronic-meds/


[ii] Review of Poor Medication Adherence by Darrell Hulisz, RPh, PharmD


[iii] Richard, C., Glaser, E. and Lussier, M. (2017), Communication and patient participation influencing patient recall of treatment discussions. Health Expect, 20: 760-770. doi:10.1111/hex.12515


[iv] 15 Frightening Stats on Medication Adherence (Plus Infographic) Written by Jeff L. May 16, 2018


[v] Medication Nonadherence in Older Adults: Patient Engagement Solutions and Pharmacist Impact NOVEMBER 06, 2018 Amanie Khairullah, PharmD Candidate, Bryce Platt, PharmD, and Rebecca W. Chater, RPh, MPH, FAPhA


[vi] Pinto S, Simon A, Osundina F, Jordan M, Ching D. Study to Measure the Impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes. Innov Pharm. 2018; 9(1).


[vii] Chui, M. A., Stone, J. A., Odukoya, O. K., & Maxwell, L. (2014). Facilitating collaboration between pharmacists and physicians using an iterative interview process. Journal of the American Pharmacists Association : JAPhA, 54(1), 35-41.


[viii] Krumme AA, Glynn RJ, Schneeweiss S, et al. Medication Synchronization Programs Improve Adherence to Cardiovascular Medications and Health Care Use. Health Aff (Millwood). 2018; 37(1):125-133.


[ix] Payer Strategies for Improving Member Medication Adherence Rates, By Thomas Beaton, November 2017

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