When a provider writes a new prescription, a patient should go to the pharmacy to fill it and set a schedule for taking it. He or she might pop a pill in the morning with breakfast, or at night when brushing their teeth before bedtime.
This describes a desirable scenario for providers. Unfortunately, many patients don’t set out on such a routine. Filling and taking their medication isn’t a priority, and such noncompliance can cause big problems down the road, including poor patient outcomes and higher risk of hospital readmission.
The Other Drug Problem
The number of Americans not taking their medications properly is staggering. According to the National Council for Patient Information and Education, about half of the 2 billion prescriptions filled each year in the U.S. are not filled or taken correctly:
- 12 percent don’t fill their prescription at all
- 12 percent don’t take medication at all after they fill the prescription
- 29 percent stop taking their medication before it runs out
- 22 percent take less of the medication than is prescribed on the label
And the consequences? Noncompliance causes 125,000 deaths annually in the U.S., leads to 10 to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. Noncompliant patients can wind up in the emergency department with a more emergent condition or require more expensive health-care treatments. Hospital costs due to patient noncompliance are estimated at $8.5 billion annually, according to the Journal of Applied Research.
Reasons for Noncompliance
In the words of former U.S. Surgeon General C. Everett Koop, “A drug can’t work if you’re not taking it.” Researchers have been studying the reasons why patients don’t take their meds as directed. Some patients are overwhelmed and confused with the number of medications and the directions for taking them. A report from the American Heart Association notes that nearly 60 percent of patients taking five or more medications take them improperly.
Older patients may have cognitive issues while some patients have difficulty opening the medication container or swallowing the medication. Patients with high blood pressure or high cholesterol may stop taking their meds because they don’t feel any symptoms. Other reasons for noncompliance include fear of side effects or actually experiencing them, and stopping the medications to save money.
A Spoonful of Sugar
Patients, along with their caregivers, can try a number of measures to take their medications as prescribed, such as daily routines, packaging aids and reminder services that call patients directly.
Doctors also are searching for ways to help patients remember their medications to avoid being blamed, or even sued, for their patient’s poor health outcomes as a result of medication noncompliance. Physicians have been carefully documenting patient activities such as missing appointments and signing their patients up for additional medication reminder services.
Some studies show that increased pharmacist involvement improves compliance. Health-care reform includes programs that pay incentives to pharmacists for helping Medicare beneficiaries adhere to prescribed treatment, according to the Advisory Board.
According to The New York Times, paying cash incentives to patients has entered the picture. Some physicians, pharmacies and insurers have started endorsing programs that provide patients with modest financial incentives to take their medications. Cash incentives have worked for tobacco cessation and weight loss programs, and they’re hoping it will work for prescriptions, too.
In Philadelphia, patients can enter a lottery to win $10 or $100 each day they successfully take their prescription. Mentally ill patients in Britain are paid for taking antipsychotics, which has resulted in reduced hospitalizations.
Using cash incentives to increase compliance raises interesting and controversial questions such as how much money is enough, when do the incentives end and what limits should be in place? Some experts believe it is more important to motivate patients internally, rather than with cash, to take care of their health.
Yet another, and perhaps more effective, way to monitor and encourage medication compliance is the use of emerging technologies designed to create better patient oversight. A care team made up of medical professionals, the patient himself and family members can maintain a continual line of sight based on expected data inputs at key times (such as checking off in the system when a dose is taken) or through biometric feedback indicating the need for an intervention.