Over a year ago, I clipped a great article in The Wall Street Journal (“How Can You Help the Medicine Go Down?” , March 28, 2011) by Katherine Hobson and just re-read it the other day. It framed the costly problem of poor medication adherence, citing the estimate by the World Health Organization that “half of patients in the developed world don’t properly take their drugs for chronic conditions.” (p. R10) Even more alarming is reference by the article to a study estimating that nearly 90,000 people die prematurely in the U. S. alone each year because of poor adherence to high blood pressure treatment prescribed. With increasing interest in making our healthcare delivery system more efficient and less costly, many policymakers, providers, payers, and educators are tackling the challenge of improving health literacy and patient compliance. It’s receiving so much attention there is even a scientific journal devoted to the topic (http://www.patientcompliancemedia.com/) . There are also countless bloggers and consultants rushing to explain the phenomenon and to suggest solutions. Clearly, it is more than just a problem of insufficient education. The root of the problem goes much deeper and is far more complex.
As Ms. Hobson points out in her article, we first need to tap existing technology so that doctors and other healthcare providers have timely information about patients refilling prescriptions. Patients, especially younger consumers, do not necessarily fill all their prescriptions at a single pharmacy outlet or even the same chain of outlets with an integrated database, and consequently information from a single source may be incomplete at best. And just because a prescription is filled doesn’t mean the pills will be swallowed or taken in the recommended dosages. It is suspected that the more medications a person is on for multiple chronic conditions, the more likely they are to “self-medicate” and pick and choose which ones to take from one day to the next, depending on a variety of factors. At least the “pay for performance” initiatives contained in the Affordable Care Act, recently upheld by the Supreme Court, aimed at rewarding providers based on clinical outcomes and patient satisfaction will nudge along getting this information to the doctors so they can act upon it.
Pharmacies are already on top of their potential role in improving medication adherence. Ms. Hobson cites a recent study at Walter Reed Army Hospital in which a program whereby patients were educated about their medications and contacted bi-monthly by pharmacists improved their adherence from 61% to 97% after six months. Pharmacists can also suggest substitutes when they hear complaints about side effects and recommend a generic substitution if patients express anxiety about high costs. But there has to be engagement and dialogue for this to happen. And it begins with internal motivation of the individual to manage one’s personal health and wellness.
A perfect parallel case in point is winning a lifelong commitment to pelvic floor muscle exercises for bladder performance and sexual vitality. Are those goals not lofty enough? Maybe the problem is one of distraction and competing interests. Maybe we need more penalties and not just rewards for doctors in order to successfully tackle the behavioral challenges of adherence, or compliance. Until these complex topics - including the psychological ones at the heart of motivation - are better understood and addressed at the doorstep of the individual patient, our nation’s health and wellness will continue to carry a hefty price tag.
Nancy Muller, PhD
Word count: 540
Published On: July 24, 2012