Prescription Drug Adherence
1 AnswerThe Rest of Your Life (ROYL) answeredMedication compliance for a medical condition can be monitored. Pharmacy dispensing devices for the home are available. The These devices can remind you of your medication times, monitor if you're taking your medications and send reports to the "cloud" online, where lack of compliance can be detected and sent to your nurse practitioner, doctor or pharmacist.
1 AnswerMichael Roizen, MD, Internal Medicine, answeredSome people try to save money by keeping medication for possible future use, but this is a sure-fire way to get older. Once you have used a drug for its intended purpose (and in the manner prescribed), throw the rest away. Pills can change their composition over time. Also, by getting rid of extra bottles, you reduce the risk that you or others will take the wrong pill accidentally.
1 AnswerMichael Roizen, MD, Internal Medicine, answeredIf your doctor prescribes your child antibiotics or other infection-fighting meds, it's imperative that you finish the dose and not stop early -- even if symptoms subside. Stopping early or taking the wrong amount can help the little buggers develop resistance and avoid treatment next time.
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1 AnswerJill Grimes, MD, Family Medicine, answered
Finding a pill dispenser that works for you can simplify your life and increase your success with medication compliance.
Many times doctors prescribe multiple medications: One is daily, another twice a day, and yet another may be before meals and bedtime. Before you know it, you are supposed to take a half a dozen pills per day.
In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together and must be separated.
The basic pillbox that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one. There is a good reason birth control pills come in a dispenser that is labeled by day. How many times have you wondered, "Gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.
Find a pill dispenser that works for you. If you have multiple medications, consider one that reminds you. There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you.
3 AnswersCindy Haines, MD, Family Medicine, answeredFollow the directions to a "t" and make sure that you are using the dosing device that comes with that specific medication. Over or underdosing commonly occurs with inaccurate teaspoons or tablespoons used in lieu of a specific dosing device.
1 AnswerPharmacy benefit design has an important, direct influence on adherence to medicines. Higher copays and restrictive benefits lead to a reduction in use of medicines and can increase total medical costs in the long run.
A synthesis of the literature by researchers at RAND Health found a 2-6 percent decrease in prescription drug spending for every 10 percent increase in cost sharing (depending
on therapeutic class and patient outcomes). Researchers also found an unambiguous association between higher medication copays or cost-sharing and increased use of hospitalizations and emergency medical services for patients with congestive heart failure, lipid disorders,
diabetes, and schizophrenia.
Compared to seniors with uncapped prescription coverage, seniors with a $1,000 annual benefit cap under a Medicare+Choice plan were less likely to use medicines appropriately and experienced unfavorable clinical outcomes. Use of medicines to treat hypertension, high cholesterol, and diabetes was 15 percent, 27 percent, and 21 percent lower, respectively for patients subject to
the cap relative to those with full coverage. The cap was also associated with poorer control of blood pressure, lipid levels, and glucose levels, and savings from reduced use of medicines were offset by increases in the costs of hospitalizations and emergency care.
A 2004 RAND study found that doubling copays for medicines reduced adherence by 25-45 percent. As
patients’ use of medicines declined due to increased copays, emergency room visits increased 17 percent and hospital stays rose 10 percent among patients with diabetes, asthma, or gastric acid disorder.
2 AnswersNot taking medicines as prescribed increases health care costs and exacts a significant human toll. Poor adherence is associated with increased hospitalizations, nursing home admissions, physician visits, and avoidable healthcare costs.
Relative to patients with high levels of adherence, the risk of poor clinical outcomes—including hospitalization, rehospitalization, and premature death—among nonadherent patients is 5.4 times higher among those with hypertension, 2.8 times higher among those with dyslipidemia, and 1.5 times higher among those with heart disease.
People with diabetes who took their diabetes medicines less than 60 percent of the time were 3.6 times more likely to be hospitalized than those who followed their prescribed treatment.
In 1994, the economic impact of non-adherence was estimated at $100 billion annually, including costs from nursing home admissions and avoidable hospitalizations. A more recent estimate, based on a 2004 synthesis of the literature, puts the cost of non-adherence closer to $300 billion per year. Other research indicates that 33 to 69 percent of medicine-related hospital admissions are caused by poor adherence, with a resulting estimated cost as high as $100 billion a year.
Non-adherence has also been associated with as many as 40 percent of nursing home admissions and with an additional $2,000 a year per patient in medical costs for physician visits.
Poor adherence to medicines has been linked to 125,000 deaths each year.
1 AnswerPatients’ reasons for non-adherence are varied and complex, though researchers have identified some common predictors of poor adherence. These include:
• psychological problems, particularly depression;
• cognitive impairment;
• asymptomatic disease;
• inadequate follow-up or discharge planning;
• side effects of medicine;
• patient lacks belief in benefit of treatment;
• patient lacks insight into the illness;
• poor relationship between patient and provider;
• missed appointments;
• lack of health insurance;
• cost of required copayment or coinsurance;
• complexity of treatment;
• access restrictions.
1 AnswerThree out of four adults acknowledge not always taking their medicines as directed.
Poor adherence to medicines takes many forms, and nearly 75 percent of adults report engaging in one or more nonadherent behaviors. While the most common form of
non-adherence is simply forgetting to take a prescribed medicine, almost 30 percent of patients stop taking their medicine before it runs out and another third of patients
report not taking a prescription to the pharmacy to be filled in the first place.
Among patients who fill their prescriptions, 70-75 percent do not take their medicines as prescribed, meaning they skip doses, take less than the recommended amount, or
stop taking the medicine earlier than they are instructed to do so.
Chronic disease affects nearly one in two Americans and treating chronically ill patients accounts for $3 out of every $4 spent on medical care in America. Treatment often involves following medication regimens over long periods of time to slow disease progression and prevent costly complications. Electronic monitoring studies indicate that among chronically ill patients who fill their prescriptions, only about half actually take their medicines as directed by their physicians.
Unfortunately, doctors are unable to predict which of their patients will likely be non-adherent to treatment. As former CBO Director Peter Orszag recently noted, “Doctors are no more accurate than relying on a coin flip in determining who will adhere to treatment and who won’t (even among patients they know well).”