Medication adherence is an increasing health concern in the United States associated with approximately $100-$300 billion of healthcare costs annually. That’s especially worrisome for patients with chronic conditions, whom account for 83.1 percent of all prescriptions in the United States and require ongoing medical attention.
According to a new report, nine in ten (88%) primary care physicians (PCPs) are concerned about medication adherence of their patients with multiple chronic conditions. The independent survey commissioned by Quest Diagnostics, “Hidden Hazards: Closing the Care Gap Between Physicians and Patients with Multiple Chronic Conditions,” surveyed more than 300 primary care physicians (PCPs) and more than 500 adults aged 65 and older in Medicare with two or more chronic conditions, such as hypertension, arthritis or diabetes.
Based on the responses, it appears those concerns are warranted. One-quarter (23%) of patients say there have been times when they forgot to take some of their medications or took the wrong ones. Yet, less than one in 10 (8%) patients reported medication adherence as a concern.
Given that three in four Americans over the age of 65 have two or more chronic health conditions, what can we do, as physicians), to fix this “hidden hazard” and get our patients on the same page as their primary clinician? Here are a few of my recommendations to solve this costly problem:
1. Look for underlying issues
There may be any number of reasons why a patient fails to use his or her drugs as prescribed, many of which may not come up during the physician consult. For example, the Centers for Disease Control and Prevention estimates that 20 percent of the 3.8 billion prescriptions written every year in the United States aren’t filled.
The findings from the Quest survey also suggest that patients may not recognize or communicate all health-related issues that may impact their care and health. The number one worry cited was “getting another medical condition” (43%) and the second was “being a burden on my loved ones” (32%). Yet, two in five patients say they do not tell their doctor about loneliness, isolation, transportation barriers and other factors that influence health. Many admit they “struggle to stay on top of my health issues and need more support.” The findings are significant as approximately 80 percent of health outcomes are related to factors outside the traditional realm of healthcare delivery, including social, economic, and behavioral.
Someone suffering from a mental health issue, such as depression, also may not take medication regularly. In that case, Family Practice Management recommends treating the depression first. In other cases, financial constraints may be the culprit. A recent study found that large out of pocket costs cause some patients to skip, tragically, their oral cancer therapies. That’s why it’s important to care for “the whole patient,” by inquiring about knowledge, financial, social and other gaps that may contribute to lack of adherence.
2. Make it easier to pick-up and refill prescriptions
Mail order pharmacies are fairly common, but not every patient takes advantage of them. When possible, move your patients to mail order or encourage them to sign-up for an automated mail order service, which can take the work out of remembering to pick up or refill prescriptions. Patients are also demanding more convenience these days, so other options we as physicians should consider are taking advantage of online and mobile phone refills, or at-home delivery services. Also, try to consider wait times for refills—some pharmacies are beginning to offer to refill prescriptions in person for “10 minutes or less.”
3. Advise patients to set-up a medication reminder
According to the Centers for Disease Control and Prevention, 50 percent of people with chronic illnesses stop taking their medications within one year of being prescribed. And even among those that are filled, 50 percent are taken incorrectly, especially when it comes to timing, according to the CDC. Pill reminders that can be affixed to the medications, on medicine cabinets or on refrigerators can help solve the issue.
In addition to pill reminders, there are smartphone apps that can send patients’ reminders to take their medications. Some not only allow patients and their loved ones to track their medications, but physicians can connect with their patients to follow their adherence as well.
4. Invest in a chronic care management program
Chronic Care Management (CCM) comprise underutilized services that can help qualified patients achieve better medication adherence and overall care management. The Centers for Medicare & Medicaid Services (CMS) began to reimburse for CCM services in January of 2015 as a means of supporting patients in between physician visits.
CCM services are non-face-to-face services provided to Medicare beneficiaries who have multiple chronic conditions. CCM acts as an extension to a physician’s practice, enabling a patient to regularly connect with a qualified healthcare practitioner by phone, supplementing the traditional physician consult. A CCM professional can assist with any confusion around a medication routine, or even suggest medications that could be cheaper or easier to access from a pharmacy.
Chronic care management services that are reimbursed under these new rules include electronic and phone consultations with trained professionals. Under this arrangement, patients benefit from timely and specific consultations with trained professionals as part of chronic care management services.
PCPs who engage in chronic care management services can rest easier knowing a trained professional is following up with patients and reporting back issues through electronic health records. In fact, the Quest survey found that most PCPs – 84% — said a CCM service could help them deliver care to chronic care patients. Yet about half did not know CMS reimburses for such services. While early participation in the program by PCPs has been slow, CMS estimates 70 percent of Medicare beneficiaries—roughly 35 million people—have two or more chronic conditions and would be eligible for the care services.
Improving medication adherence can be a gradual process, but poor adherence is a hazard that can and should be addressed. Physicians that access the tools at their disposal to help patients adhere to their prescription medication regimen may expect them to be happier and healthier in the long run.
L. Patrick James, MD
L. Patrick James, MD, is a senior medical director at Quest Diagnostics. Prior to assuming this role, he served in other senior leadership roles within Quest. Before joining Quest Diagnostics, Dr. James served LabOne as Executive Vice President for Pathology and Laboratory Services. He spent nine years with Health Midwest, a 14 hospital integrated delivery system in Kansas City, as Medical Director of Hospital Integration Dr. James’ experience spans Research Medical Center, St. Joseph Hospital in Denver, Colorado, and National Naval Medical Center in Bethesda, Maryland. Dr. James earned his medical degree with honors from St. Louis University. He performed his internship and residency training in anatomic and clinical pathology with board certification at the National Naval Medical Center and post-graduate training in cytopathology with board certification at Johns Hopkins Hospital.