Many patients who are prescribed medications fail to take them appropriately—or at all—and addressing this problem could lead to significant cost savings and better care management, according to a new report.
Medication nonadherence is a common problem, according to The National Council for Behavioral Health’s Medical Director Institute. The group's report (PDF) estimates that half of people on any medication fail to take it as prescribed.
To address the issue, the institute issued a series of solutions that stakeholders across the health system can use to ensure patients are using drugs correctly. If a “substantial” number of the ideas in the report were adopted by 2025, the institute projects $2 billion in annual savings from reduced hospital costs alone.
“This isn’t a matter for just patients, doctors and clinics,” Joe Parks, M.D., the council’s medical director and founder of the institute, told FierceHealthcare.
The solutions include:
- Better communication between physicians and patients.
- Increased use of risk assessment to determine patients least likely to take medications correctly.
- Greater use of long-lasting injectables over medications taken at home.
- Increased patient access to pharmacy services.
- Enhanced data-sharing to flag instances of non-adherence.
Parks said the first point—improved communication—is a crucial place to start but may be one of the hardest concerns to address. Patients may not feel comfortable voicing concerns about the medications they’re on or may hesitate to admit that they stopped taking them entirely. But, Parks said, doctors need to have the time to ask those questions.
1 in 6 Americans – about 54.3 million people – take a psychiatric drug. On average, half of all people on any medication do not take it as prescribed. Our Medical Director Institute is directly responding to this with a new call to action: [https://t.co/7chFV3T6EH ] #BH365 pic.twitter.com/COl05xHB1M— National Council (@NationalCouncil) September 19, 2018
For example, a psychiatric patient who presents in a clinic may report a continued struggle with his or her depression, Parks said, which is a result of that patient choosing to stop taking the antidepressant he or she was prescribed. If he’s not made aware that they’re no longer on the original medication, the doctor could end up prescribing a second medication or a higher dose—exacerbating the problem instead of solving it, he said.
“It’s often hardest to do the simpler things really well,” Parks said. “So much of this is dependent on how good the communication and feeling is between the prescriber and patient.”
Physicians should also start asking patients about their habits around taking medications to better assess upfront for risk of nonadherence, he said. That’s information patients aren’t likely to bring up on their own.
Payers can play a crucial role in improving medication adherence and stand to benefit significantly, too, Parks said. Abrupt formulary changes, for one, can lead some patients to abandon their medication regimens, so those kinds of adjustments must be thoughtful.
Insurers can also ease patient access to pharmacists, which can boost adherence. Some patients, for example, can benefit from medication blister packs that delineate daily medications, but that isn’t always covered by insurance.
Parks said that the payers may not be seeing the bigger picture—that paying upfront for the blister packs would lead to overall greater savings when a patient’s condition is well-managed.
“We just think they haven’t given this enough thought,” Parks said. “It bears more attention and detail.”