Medication Non-Adherence Significantly Increases Healthcare Cost
Medication adherence is a new buzz, filtering through the halls of hospitals and in and out of the offices of many health care executives. With the passing of the Affordable Care Act, health care teams have created an intense focus on health care costs. One such disparity that stands out rather significantly is the cost associated with patients not taking their medications as prescribed, or in other terms, not being adherent to their medication regimen.
Medication non-adherence, which includes delaying or failing to fill prescriptions, cutting dosages, and reducing the frequency of administration causes an estimated total cost in the United States from $100-$300 billion each year. More than 3.2 billion prescriptions are filled each year in the United States and over half of them are non-adherent. Estimates show that the cost of hospitalizations related to medication non-adherence is approximately $100 billion per year.
Why are Patients Non-Adherent
There are many reasons why patients are not adherent to their therapy; however, they are usually associated with one of the following:
Limited access to medications due to cost or insurance issues.
Medication dosed multiple times daily or patient taking multiple medications.
Side effects decrease desire to take therapy.
Physical (wheel chair, hearing, sight etc…) or social (language, cultural) issues limit access.
Cognitive function issues limit ability to adhere to medication regimen.
Patient does not feel sick (for example, high blood pressure or cholesterol) so they don’t take their medication.
Lack of education or understanding about why they are taking their medication or lack of understanding of the consequences of not participating in their pharmacy therapy.
The process of defining exactly what is the most effective mechanism for improving medication adherence has spurred a plethora of entrepreneurial companies addressing the issue. This is fantastic. Regardless of which concept is the most effective, the continuing result will be that the topic of medication adherence is finally being addressed in a meaningful and collaborative fashion.
Throughout the country there are many businesses and organizations working on different concepts of how to increase medication adherence.
One such organization, Adhereforhealth.org has created a partnership called Prescriptions for a Healthy America. Their goal is to advance medication adherence by working with elected officials and policy makers to help create solutions that will advance the medication adherence environment.
Performing a simple internet search will reveal a multitude of different companies that offer various devices and applications aimed at medication adherence. Many of these devices offer daily or weekly medication storage capabilities and may be equipped with some sort of alarm mechanism to alert the patient when to take their medication. The smart phone world has addressed the medication adherence need by developing many different choices of medication reminder apps.
Pharmacists have become involved in hospital multidisciplinary teams that help coordinate patients discharge from hospitals. It is not uncommon these days for a pharmacist to visit a patient in their room prior to discharge and discuss their medication profile with them, assuring that the patient understands all of the important counseling information involved with their specific medications. After discharge, the pharmacist may then perform a follow-up phone call within 3-5 days to assure the patient has picked up their prescriptions and is adhering to their regimen. This communication is all about engaging the patient in an educated discussion about their pharmacy regimen so they may better understand the importance of their therapy and the consequences of not adhering to their pharmaceutical regimen.
Medication Therapy Management (MTM) is another mechanism aimed at increasing patients awareness and understanding of their medication treatment. Either through an employee wellness plan, insurance company or private contracting a patient may enroll or be signed up for a MTM session with a pharmacist. The pharmacist will review the entire medication profile and offer education and suggestions as needed.
Who Educates and Manages Medications for Millions of Patients Who are not Hospitalized
One particular area that needs addressing are the millions of patients who are not hospitalized, not introduced to a multidisciplinary team, and are not enrolled in an MTM program to help educate them and manage their medications. The American Hospital Association stated there were 36.5 million hospital admissions in 2011. This is a very small number when compared to the 3.2 billion prescriptions filled each year. These are the patients that need medication education.
Daily, patients pick up prescriptions from busy pharmacy counters or receive prescriptions in the mail. Patients rarely receive the complete counseling and education they need to fully understand their pharmaceutical therapy. The Omnibus Reconciliation Act of 1990 states that patients will be counseled on all new prescriptions. Furthermore, OBRA 90 defines the minimum information necessary for a complete counseling session. The American Society of Health System Pharmacists took a step further to define guidelines on how a pharmacist may best educate patients about their medications.
Current barriers to effective medication counseling do not regularly allow for the pharmacist to sit with patient to discuss their medications for 10-15 minutes at the pharmacy counter. Pharmacists are under tremendous pressure to meet their performance metrics and will regularly cover the counseling points of three or four medications with a patient in fewer than two minutes. Furthermore, the patient is in a hurry to get their medication and leave and may not fully pay attention to the pharmacist at the counter. The patient is sent home with stacks of informational paperwork that is cumbersome to read and usually ends up in the fireplace or recycling can.
Then we have mail order pharmacy to contend with. If a patient is to get a counseling session, they need to phone the mail order pharmacy, wait for a pharmacist, then discuss their medication information with a pharmacist in another state. This may work well for some people; however, quite often patients may just try to search out their own information on the internet. How is a patient to narrow down all of the information to just the OBRA 90 specific, important counseling information?
Recorded Audio Counseling Sessions May Improve the Medication Counseling Gap
Recorded medication counseling sessions effectively bridge the medication education counseling gap between the patient and their health care providers. Patients logon to the AudibleRx website, navigate to the medication they want to learn about, click on the link, then listen to a 6-8 minute Medication Specific Counseling Session describing all of the OBRA 90 counseling information for that specific medication. After listening to a session a patient will have a clear idea of what they do and don’t know about their medication and will be in a position to take educated questions back to their own health care provider.
It is important to understand that the digital recordings provided through AudibleRx are meant to supplement a patient’s education and understanding of their medication and are not a legal replacement for their face to face counseling session with their own pharmacist. The sessions may be accessed on any internet enabled device with a speaker, no downloading necessary.
Patient medication education is only one aspect of medication adherence; however, as stated in a recent report from the Agency for Healthcare Research and Quality, “Our findings suggest that educational interventions and case management approaches offer the most consistent and voluminous evidence of improvements in medication adherence across varied clinical conditions.” With that statement in mind, providing access to digital/audio, OBRA 90 based Medication Specific Counseling Sessions would be an incredibly simple measure to implement for any organization with a desire to increase the medication adherence of their clients.
About the Author
Steve Leuck, Pharm.D., is President/Owner of AudibleRx. AudibleRx provides OBRA 90 based Medication Specific Counseling Sessionsin digital/audio format. Both individual and group memberships are available. Dr. Leuck also works full time as a community pharmacist in a clinic setting where he practices his counseling on a daily basis.
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