Thursday, April 5, 2007

Take A Pill...Call me in the Morning: Why Medication Adherence Poses a Dilemma to Doctors and Patients

Nearly 50 percent of medication-related hospital admissions in the U.S are due to poor medication adherence, A recent study of 39,000 patients and 335 primary care doctors by the Consumer Reports National Research Center, published in the February 2007 issue of Consumer Reports, noted that doctors’ number one complaint about patients is their failure to follow advice and adhere to a treatment regimen, which results in the high numbers of people landing in the hospital or back at a doctor’s office with the same complaint that they brought to their physician days or weeks earlier.

The reasons for this non-compliance are complex. Many individuals stop taking a medication that has been prescribed as soon as they are feeling better, even if the instructions definitively indicate that all medication is to be finished. A majority of individuals with chronic conditions are notorious for stopping their medication within six months of their diagnosis. Why is that the case? Strange as it may seem many people simply forget. Others believe they do not have to bother, and there are some who are more fearful of long term complications from the medication than long term complications from the disease.

There is a communication gap here that needs to be closed. Most physicians prescribe a treatment and assume that their advice will be followed. However, the 21st Century healthcare consumer will tell you that they do not receive enough information from their physician about how to treat a problem, the costs associated with the treatment and the side effects. As a result they do not follow the doctor’s directions.

Whether the problems stems from a doctor who does not know how to communicate effectively, an office visit where there is not enough time for the detailed explanations required, or patients who simply choose not to listen, non-adherence is a serious issue that threatens to undermine an already floundering healthcare system.

Some of the more innovative practices that could address non-adherence in a more effective way include:

1. E-Prescribing systems that provide complete information to consumers on the cost and side effects of their medication and the best way to take those medications.
2. Pharmacist-consultants who work with physicians to assume responsibility for filling prescriptions and serve as advisors to patients by helping them understand the way to take medications more effectively. These pharmacist consultants also monitor patients daily or weekly to be sure the regimen prescribed is the regimen followed.
3. Patient portals – locations on the Internet where patients in a secure environment can communicate with their physicians – ask questions about their treatment and hot link to web sites that provide information and interaction with other individuals who might have the same problems or questions.
These digital technology solutions are enablers that benefit providers and consumers.

1 comment: said...

R/x limitation

Recently had a client that was told that they could only receive 30 pills per month of their prescribed pain medicine for their shoulder surgery recovery.
When we pushed their ins. company about this they stated that they were only following FDA and their own guidelines. It was a powerful pain r/x and perhaps they were concerned about being held liable for an adverse reaction if they had approved 60 pills, as our client stated the doc. prescribed, for one months treatment. I realize many will state that they were just trying to save themselves money. Any thoughts on this?


Joe Jessome
Smart Health Insurance Inc.
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