An Engagement Regimen for Medication Adherence

Drug spending in the United States is astronomical, and Americans are noticing. According to a Kaiser Health Tracking Poll for August of 2015, while 62% of Americans concede that prescription drugs developed in the past 20 years have improved peoples’ lives, 72% of Americans feel that drug costs are unreasonable. Support for various efforts to lower drug prices crossed partisan lines. Tackling drug prices through legislative efforts, like allowing the federal government to negotiate with drug companies for drug prices for people on Medicare, is an effort supported by many Americans (Kaiser 2015). Yet, even with efforts to lower drug prices, drug spending in the United States still raises following question for prescribers: why put patients on highly expensive drug regimens if they are not going to adhere to their medication plan?

What is medication adherence? The term refers to whether a patient takes their prescribed drugs and follows their chosen treatment plan, and there is evidence that non-adherence is associated with poor health outcomes and higher cost of care. This is especially relevant for diseases like diabetes or gastrointestinal disorders; successful outcomes for both depend on adhering to the full course of a prescribed drug regimen in addition to self-management of lifestyle aggravators such as stress. Not surprisingly, drugs for both heartburn and diabetes showed up in the list of top ten drugs that Medicare pays for in its Part D prescription program.

Lack of adherence is certainly not the only factor driving up drug prices (though pharma-funded adherence advocacy organizations certainly would like us to think so), but addressing the issue of non-adherence is still a valuable cause. According to this blog post, major strategies for making the most of expensive medications through adherence should focus on patient engagement, taking a longer view of the patient, and greater pharmaceutical manufacturer involvement in personalized medication management programs. The bottom line is that medication non-adherence wastes expensive drugs and puts people in danger of poor health outcomes, which in turn increases cost of care. We cannot ignore the link between medication adherence, drug spending, and quality of care.

So how do we achieve medication adherence? Within the movement toward more personalized forms of health care delivery, an ever-growing number of initiatives are searching for ways to increase positive self-management behaviors and health self-efficacy. As highlighted above, patient engagement is one of, if not the most important strategy for addressing drug adherence behavior. Patient engagement itself has been deemed a “blockbuster drug”, so using it as a conceptual framework for linking self-efficacy and health behavior with prescription drug adherence seems fitting. The theoretical connection between the two seems valid; more engaged patients should be more involved in their care, understand their treatment regimen, and follow through with it. Pharmaceutical companies recognize the importance of this issue, as evidenced by efforts to connect engagement with adherence in upcoming conferences and summits nationwide.

If patient engagement is the fix, what do current strategies for improving patient engagement as it relates to medication adherence look like? While industry focuses on medication adherence programs, like this suite of resources from McKesson, healthcare researchers have focused on fostering patient-centered care, developing shared decision making, self-management programs, or continued engagement support through mobile health platforms. Others, like the Altarum Institute and OptumHealth, are using patient engagement as a potential predictor variable for future (non)adherence.

The Center for Research on Personalized HealthCare is conducting research on a model of care with the flexibility to combine many of the above strategies in both primary care and group settings. Personalized Health Planning combines patient-centered care with shared decision-making and mechanisms to support long-term self-management of multiple disease states. The process engages patients in all aspects of their care, and therefore has the potential to make an impact in the realm of medication adherence.

Though special interest groups have a part to play in highlighting adherence and its relation to the medication pricing and cost of care issues facing the US, their self-serving motivations should not deter researchers from addressing the problem. Medication adherence is inextricably linked to efforts for creating more personalized, proactive forms of care.

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2 comments on “An Engagement Regimen for Medication Adherence
  1. Coralie W says:

    I can see how a shift towards personalized health care would indeed lead to an increase in medication adherence, especially for those who are taking a cocktail of medications used to treat chronic conditions. The benefits of a group setting in personalized health care could extend beyond medication adherence. I think it would also be helpful to have an educational aspect of medication adherence and the risks associated with non compliance. Of all medication-related hospitalizations that occur in the United States, between one-third and two-thirds are the result of poor medication adherence (Osterberg 2005). While a stay in the hospital itself is extremely costly, the costs of the stay in the hospital due to poor medication adherence on top of the cost of medication is counterintuitive to the end goal of the medication, which is treatment for the symptoms. I think that people would be more conscientious of medication adherence if were educated on the risk of noncompliance. If education on adherence in the group setting of personalized health care is unsuccessful, then we need to reevaluate better methods to have patients take responsibility over their medications and health.

    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497

  2. Amani Carson says:

    This offers an enlightening primer on medicine adherence for the new reader. I agree medicine adherence is a real problem in the United States, but two implications in particular struck me. One, if medication adherence is an unresolved issue that is increasing the costs of healthcare, then why are physicians still prescribing expensive treatments to individuals unlikely to adhere to their regimen? Is this the result of limited access to treatment alternatives, of limitations in physician training, or some other factors? How can physicians prescribe less expensive medications at least until nonadherence becomes less prevalent or has less of an impact on healthcare costs? Two, treatment regimens for conditions like diabetes or gastrointestinal disorders being so dependent on adherence to “the full course of a prescribed drug regimen in addition to self-management of lifestyle aggravators such as stress” illustrates a catch-22 in the American healthcare system. Typically, the people who suffer from diabetes and gastrointestinal problems are part of disadvantaged populations who cannot always control their access to expensive medicines and the level of stress in their lives. Specifically, these demographics are predisposed to such illnesses because they are less likely to maintain a healthy diet, exercise regularly, live with manageable amounts of stress, and seek mental health treatment for stress-management. It’s challenging to address the healthcare needs of these patients without making structural changes because their likelihood of adhering to the medication regimen prescribed is systematically unreliable.

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