Medication adherence is not a new issue but remains a significant one as we move into a new decade in 2020. Simply put, drugs do nothing for a patient who does not ingest them – and if we cannot ensure that our patients are properly adhering to their advised medication regimen, we cannot properly address their symptoms and treat them.
Medication adherence is neither a simple issue nor a small one, as several different studies have indicated that more than half of people do not take their medication as instructed by their healthcare provider. Consequently, medication nonadherence (a lack of medication adherence) is linked to poor health outcomes, poorer quality of life, and much higher costs for the healthcare system, and the economy in general.
Various products, interventions, and techniques have been developed and devised in an effort to reduce medication nonadherence, but with little success.
It remains difficult to pinpoint what works and what doesn’t, as patients share different reasons for their medication nonadherence, including simple forgetfulness, inability to afford medication, poor memory due to their condition, lack of time, lack of medical literacy, or fear of adverse effects. When working to identify ways to help you increase medication adherence in your patients, it helps to employ strong listening skills, and prepare to utilize a number of potential fixes and interventions.
What is Medication Adherence?
Several definitions have been proposed for this phenomenon, which was first studied in 1968, yet is likely much older. The fact that some patients will not listen to medical advice is a given, but it becomes a serious problem when a significant number of patients do not follow their healthcare provider’s instructions for care.
The WHO offers a concrete definition of adherence: “the extent to which a person’s behavior – taking medication, following a diet, and or executing lifestyle changes – corresponds with the agreed recommendations from a provider.” When a patient displays nonadherence, they are indirectly communicating that they face a significant roadblock preventing them from procuring and/or taking the right medication, in the right dosage, at the right time.
More than even the development of new drugs, the improvement of adherence strongly influences health outcomes for the better. It is, simply put, in every physician’s best interest to do their utmost to maximize adherence in their patients.
Medication Adherence is Critical in Chronic Conditions
More so than in other illnesses, a lack of medication adherence is a significant problem in patients with chronic conditions. Currently, roughly 50 percent to 60 percent of all people affected by chronic illnesses display some form of nonadherence, for one reason or another.
Chronic illnesses need to be managed carefully and consistently, and failure to do so can lead to the development of worse symptoms, or rapid deterioration in quality of life and overall health.
Patients with chronic illnesses are often regularly in touch with their primary care providers or the respective specialist who is treating them, yet despite that, many continue to struggle to adhere to the treatment they are given. More needs to be done to ensure that patients with chronic conditions are carefully monitored and interviewed to ensure medication adherence.
Increasing Adherence: What’s in the Way?
To identify the best way to address medication adherence issues, it’s important to understand what stands in the way of adherence for any given patient. There is a litany of reasons why a person refuses to take their medication or stick to the recommended treatment plan, and most of these reasons develop over time. No one simply decides to stop following their doctor’s orders. Getting to that point requires a number of different mental roadblocks, which may contradict advice given by a medical professional.
Research does show that five general factors can explain nonadherence: economic or social challenges, healthcare system related challenges, therapy related challenges, condition related challenges, and patient related challenges.
To further break this down, the first and largely most important roadblock against adherence is treatment cost and socioeconomic condition. Patients who cannot afford their medication will not take it.
Among healthcare systems, factors that influence adherence include the patient-provider relationship, prescriber follow-up, the complication of having multiple providers (and conflicting advice), and the nature of the provision itself (pharmacies that are inconveniently located, waitlists, complications).
Factors related to a patient’s condition can also affect adherence. If the condition is severe enough or if certain characteristics affect adherence (such as mental health issues in cases of schizophrenia and bipolar disease, or memory problems in dementia), interventions must be applied to address these issues directly. The nature of a condition may also affect its treatment. Patients begin to forget taking their medication if their condition is chronic or stop taking it once symptoms subside (despite advice against this).
Patient related factors can be more complex to tackle, as they may require identifying and dispelling a patient’s own views on what is required, as well as their health literacy, and their own motivation regarding self-care. Some patients don’t want to get better.
Therapy related factors relate to nonadherence due to fear of potential adverse drug reactions, or the perceived excessive length of the treatment, or the intimidating number of medications needed to treat the condition. The more complex a therapy, the harder it is for a patient to completely stick to the program.
Each of these factors represents a different roadblock, with its own potential solutions. Physicians need to identify a series of measures that they can implement to better screen patients for potential factors of nonadherence, alongside measures they can take to tackle said factors before they become a problem. Proposed solutions include behavioral intervention (including therapeutic techniques that have proven successful, such as cognitive-behavioral therapy), a better patient-provider relationship, simpler language, measures taken to improve a patient’s health literacy, and direct dispensing (and other means of simplifying the delivery of medication).
How Direct Dispensing Can Help Physicians Influence Adherence
Direct dispensing or physician dispensing presents an opportunity to improve medication adherence in most states, where it is an allowed and regulated practice. While physicians traditionally administered and provided medication, that responsibility has largely shifted to pharmacies, while physicians are tasked with prescribing medication instead.
However, systems can be implemented in many clinics and practices to streamline the process and ensure that patients receive the medication they need upfront, without going through a pharmacy to follow-up on a patient’s adherence.
ProficientRx works with physicians and other healthcare professionals to implement an effective system to help practices and clinics begin direct dispensing to their patients. With a responsive customer care team, an easy-to-use web-based service, and the resources to help businesses throughout the country, we at ProficientRx help you get your clinic on track for implementing point-of-care dispensing as quickly as possible, depending on your location and state.
Specializing in repackaged medication, we ensure that our clients are stocked with a responsive and lightweight dispensing program, catering to private practices, care organizations, hospitals, and clinics. With over 50 years of experience, we adhere strictly to every regulatory program in the industry, and always work closely with our clients to ensure that their dispensing services comply with every rule and are up to the latest standards.