Solving America’s Other Drug Problem

Pills, Medicine, Medical, Health, DrugBy Frannie Raede, MPH, PhD, program manager, commercial development, Pillo Health.

In the U.S., 25% to 50% of all adults fail to take their prescribed medications on time, contributing to poor health outcomes, over-utilization of healthcare services, and significant cost increases. Failing to follow prescribed treatment regimens can have tragic consequences for patients and their families, and lead to complaints filed against pharmacists and physicians. One study estimates that medication non-adherence causes approximately 125,000 deaths and 10% of hospitalizations annually, and costs the U.S. healthcare system up to $289 billion each year.

Forgetfulness is the primary cause of non-adherence, but there are many other reasons why a patient doesn’t follow a treatment protocol, such as carelessness, fear, supply, cost, lack of information, or not understanding instructions.

Medication non-adherence is too costly to ignore, both in terms of the price to our healthcare system and the overall health and wellbeing of our nation. As the U.S. population ages, the problem will become more acute, with a greater number of older adults battling chronic diseases and conditions.

So, what can be done to reverse the trend?

Insufficient Information

Current adherence measurements do not paint a clear picture of medication habits, which can impact progress (or lack thereof) relayed between a patient and their provider.

The most frequently used measure of adherence is the Medication Possession Ratio (MPR), where an 80% MPR is considered passing. This is defined as the number of days in supply period, over the difference between the first and last fill dates. MPR ranges from 0 to 1, with 1 representing full adherence. The possession ratio is equal to the total day’s supply fill in a period, divided by the number of days in a period. This ratio is then multiplied by 100 to obtain the percentage of possession.

In theory, an 80% MPR means a patient is taking most of the medication they are prescribed during a certain time frame, but this measurement is not precise. The calculations are usually based on insurance claims data, and therefore do not account for the use of free samples or regimen changes. They also do not provide information beyond possession—for instance, if the medication was taken, if the correct dose was used, or if it was taken at the right time.

These measurements often assume that patients are taking their medications correctly just because they picked them up from the pharmacy. To provide optimal care, healthcare providers need to better understand their patients’ medication behaviors so they can track progress and intervene when necessary, especially in cases where it’s essential a medication is taken correctly to protect a patient’s health.

For example, gabapentin can be an effective treatment for neuropathic pain when taken on the prescribed schedule, but when not taken at the right time, it can put patients in an altered mental state. For these patients, an extended release version of the drug, which releases the drug slowly over time, may be more appropriate. Current medication adherence measurements do not provide doctors and caregivers with insight into how and when their patients are taking medications, which can prohibit them from reaping the greatest benefits of the medicine.

The Consequences

Average medication adherence in the U.S. has held at 50% for decades. The outcome has been sub-par adherence, resulting in higher healthcare costs and an estimated $1 trillion loss to the U.S. economy. The costs associated with non-adherence are compounded for the nearly half of all adults in the U.S. who have a chronic disease and take at least one prescription drug.

If medication adherence improves, the greatest savings would be realized in caring for older adults (65+), including fewer emergency room visits and hospitalizations.

Another benefit that can be associated with improved adherence is a decrease in mortality. For example, low adherence has been linked to a nearly 2% increase in mortality among people with type 2 diabetes. For people struggling with chronic conditions – especially older adults – and their family caregivers, the psychological, emotional, and physical impact of non-adherence can result in serious consequences for their health and put undue strain on family relationships. Effectively addressing the main causes of medication non-adherence could significantly improve health outcomes for people living with chronic illness.

The Answer

Existing efforts to improve medication adherence target behavioral, social, and demographic factors, but these are only part of the solution. There is still room for vast improvement in adherence rates, and some of the latest technologies can potentially have a major impact—both on medication taking behavior, and availability of and access to information.

Advancements in artificial intelligence, voice technology, and robotics are being incorporated in technologies aimed at improving efficiencies in medication adherence and tackling issues related to forgetfulness, misinformation, fear, confusion, loneliness, and carelessness.

Medication adherence doesn’t occur in a doctor’s office, with a physician looking over your shoulder to enforce it. It doesn’t happen at a pharmacy, when you pick up your prescription. The environment for medication adherence is most commonly in the home, and in-home health technologies are enabling solutions to this gap that is currently unobserved.

To reverse the trend of non-adherence, patients’ behavior at home needs to be analyzed and enabled in a way that becomes second nature, with a low barrier to entry. In-home tools that proactively engage users when it is time to take a dose and improve attention to health regimens can be helpful in equipping patients with the right tools and information to stick to their medication protocol.

In addition to improving medication habits, the data collected from these technologies will also give healthcare providers a better understanding of their patients’ medication habits and give visibility into potential barriers to adherence. This will enable them to prescribe more appropriate regimens or address non-adherence behaviors, ultimately improving health outcomes and lowering overall healthcare system costs.

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