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NEW YORK — As prescription drug therapy assumes increasing importance in this country’s health care system, medication adherence has emerged as a key variable in determining its efficacy. Results from Boehringer Ingelheim’s Pharmacy Satisfaction Pulse survey indicate that most pharmacy patients are taking adherence seriously.
The poll of 34,424 adult pharmacy customers showed that just under 20% said they had decided not to fill a prescription in the past year — a figure that was unchanged from the two preceding years.
The number of survey participants who opted to stop taking their prescription medication without consulting a physician edged up slightly (17%) over the 16% who did so in the two previous years.
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In terms of day-to-day adherence, greater variability was apparent. For the last three years slightly more than 70% of participants claimed not to have missed a single dose within the last seven days.
Adherence gets a little shakier, though, when the time frame is extended to 30 days, with 21% admitting they had missed taking their medication three or more times in that span, while 11% said they missed two doses and 13% acknowledged they had missed one dose. Perfect adherence across 30 days thus dropped to 56% from 71% for a seven-day span.
It should be noted that nonadherence in a broader sense is not limited to failing to take a prescribed dose or discontinuing a medication; it can also consist of taking more or less of a medication than prescribed or, in some cases, taking a dose at the wrong time. The consequences of nonadherence are sobering. Some estimates peg the number of annual deaths from nonadherence at about 125,000, while estimated costs to the U.S. health care system range between $100 billion and $300 billion per year.
In any case, with some 133 million people, or 45% of Americans, suffering from at least one chronic condition, nonadherence is of major importance. In the case of such chronic conditions as diabetes and hypertension, which are disproportionately common among minorities, proper adherence is estimated at only 50% to 65%.
In fact, while some pharmacy patients are underutilizing their medications, another sizable segment of Americans overuse such medicines as opioids, depressants and stimulants.
Older adults, and particularly seniors, are especially at risk of nonadherence. Seniors who live alone without the aid of a caregiver and who may have memory problems, vision or hearing problems or difficulty in handling medication bottles or pillboxes all run a greater chance of failing to adhere to a prescribed course of medication.
Nonadherence, of course, is a problem that extends well beyond the interaction between pharmacist and patient. In fact, a recent study by researchers at the University of California, San Francisco; San Francisco General Hospital and Trauma Center; and the Kaiser Permanente Division of Research has identified that ineffective communication between patients and their doctors is a significant contributor to poor drug adherence.
The study, which was published in JAMA Internal Medicine (formerly Archives of Internal Medicine), followed 9,377 patients taking medications to lower their blood sugar, blood pressure or cholesterol. The results showed that patients who rated their doctors as poor communicators were less likely to adhere to their prescriptions.
Effective communication is critical in the pharmacist-patient relationship as well, and the Pharmacy Satisfaction Pulse survey has given pharmacists very high marks for engagement and expressed a high level of satisfaction with pharmacists and their staffs. Chain drug stores, however, trail other retail channels on those measures, and with 47% of chain customers reporting that they rarely or never interact with their pharmacist, engagement clearly represents an opportunity for improvement.
With many chain drug locations handling extraordinarily large prescription volumes daily, the challenge is one of balancing pharmacy processes and staffing levels with store and pharmacy labor budgets. If community pharmacy, and especially chain pharmacy, is to effectively shift to a medication therapy management model, then work flow and staffing levels will have to be adjusted to meet that model.
Needless to say, the problem of nonadherence is not only huge, but complex, as the preceding discussion should illustrate. Beyond the relationship and communication between patients and their health care professionals lies the area of costs: For Americans who are uninsured or underinsured, the decision to discontinue a prescription or to diverge from proper dosage to extend the script and put off the cost of renewal represents the sacrifice of physical for financial health.
Consequently, trends that can reduce the cost of medication, such as increasing the share of generic drugs, can help improve adherence. But as the online blog of Health Affairs stated last August, the most effective strategies for improving adherence involve trusted health professionals — including pharmacists — taking the time to engage with patients.
