May 9, 2008 
There are numerous studies on this, but they all point to the same issue…compliance.
The National Council on Patient Information and Education (NCPIE) released a report last year that I just came across titled “Enhancing Prescription Medicine Adherence: A National Action Plan“. With only 50% of patients using medication as prescribed, the systemic costs are enormous – $177B annually according to their estimates.
“Besides an estimated $47 billion each year for drug-related hospitalizations, not taking medicines as prescribed has been associated with as many as 40 percent of admissions to nursing homes and with an additional $2,000 a year per patient in medical costs for visits to physician’s offices.”
- Between 40% and 75% of older people don’t take their medications at the right time or in the right amount.
- As few as 30% of adolescents take their asthma treatments as prescribed.
Look at this in light of the recent study that showed about a quarter of people share drugs. Another huge problem.
Their 10-step national action plan includes:
- Elevate patient adherence as a critical health care issue
- Agree on a common adherence terminology that will unify all stakeholders
- Create a public / private partnership to mount a unified national education campaign to make patient adherence a national health priority
- Establish a multidisciplinary approach to compliance education and management
- Immediately implement professional training and increase the funding for professional education on patient medication adherence
- Address the barriers to patient adherence for patients with low health literacy
- Create the means to share information about best practices in adherence education and management
- Develop a curriculum on medication adherence for use in medical schools and allied health care institutions
- Seek regulatory changes to remove roadblocks for adherence assistance programs
- Increase the federal budget and stimulate rigorous research on medication adherence
I am a little surprised that they didn’t talk about technology. Integrated electronic medical records, personal health records, etc. Since at least 1/4 of people don’t even fill their initial script, I don’t see how we can address adherence without beginning there and providing full lifecycle data to physicians about the status of scripts and refills. I think there is also a huge role for collecting data about why people fill or don’t fill.
Enabling Healthy Decisions 
What so much of this comes down to is good patient-caregiver
communication. Research shows that when that exists, medication adherence goes up. Teach physicians how to improve their communication with patients and you’ll see those abysmal statistics on adherence improve.
George, you are right.
Medication non-adherence is at an all time high, costing more like $300B annually in unnecessary healthcare costs and lost revenue. 20-25% of employers’ health care costs are due to complications from medication non-adherence.
Increasing medication adherence with chronic disease states can reduce costs by up to 60% in some cases – eg. you don’t take your blood pressure medication (32% of patients are non-adherent), you have a heart attack, and have to go to the hospital – this will cost about $7- $10K and is easily avoidable by adherence to your medication. Asthma patients as well can avoid attacks, but when they are feeling good, they cannot be bothered with taking their meds. Same with Diabetes patients. Adherence saves lives.
84% of patients cite simple forgetfulness as the reason for not taking their medications. When asked why their first prescription isn’t filled, 39% cite they did not need it, 34% cite too costly, 21% cite no insurance coverage, and 19% cite side effects. There is a breakdown in communication between the doctor and patient, and a cost factor. (all stats from Wilson Rx 2007 Pharmacy Satisfaction Digest)
I think ePrescribing can help with filling that first script with a mail order program or auto fill at the MDs office to eliminate that wait time and forgetful factor between office and pharmacy. I found a script for my wife that was two weeks old in a drawer. She didn’t have time after her appointment, then forgot to get it filled. Simple reminders can help as well for filling, refilling and taking meds.
As far as NCPIE, they are trying to work within the faulted system and look at a bigger picture (I think) with their call to action. After their report came out in August, AHRQ said that medication adherence would be their next big campaign, but they still haven’t done anything about it. I have spoken with reps from both agencies, and they just haven’t embraced how technology – PHRs, reminders, etc… – will help this pandemic. And they are slow to act.