WASHINGTON — The National Council on Patient Information and Education (NCPIE), a coalition including key pharmacy industry stakeholders that aims to improve communication on the safe and proper use of medicines, has released a 10-step Adherence Action Agenda that highlights the costly problem of poor medication adherence.
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NCPIE said Tuesday that the report, "Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda," emphasizes the issue of medication compliance among those age 65 and older with multiple chronic conditions, who are at the greatest risk of medication errors, drug interactions and costly disease complications.
According to the study, poor medicine adherence among patients with chronic and comorbid conditions is resulting in unnecessary disease progression and disease complications and the rising use of expensive avenues for health care, such as emergency rooms, hospitalizations, avoidable hospital readmissions and post-acute care.
Estimates cited in the report show that caring for approximately 27% of Americans with multiple chronic conditions accounts for 66% of the nation’s health outlays and is a major source of Medicare spending.
Of the $300 billion Medicare spent in 2010 on health care, beneficiaries with six or more chronic conditions — about 14% of the Medicare population — cost $32,658, or three times the national average. As a result, the price tag for treating patients with six or more concurrent diseases was over $140 billion, or almost half of Medicare’s total spending.
"Although the challenge of poor medication adherence has been discussed and debated extensively, what is lacking is the clear recognition that prescription medicine use and the rising prevalence of chronic and comorbid conditions are inextricably linked and together, represent a major opportunity to address this health threat," explained Ray Bullman, NCPIE’s executive vice president. "This report is intended as a wakeup call that action is needed now to confront this combined threat, before the predicted continuing upsurge of chronic conditions overwhelms the health care system."
The action plan was developed in collaboration with nearly two dozen professional societies, voluntary health organizations, consumer and aging organizations, government agencies and industry leaders and based on evidence that multiple medicine use is common among older Americans, especially those with multiple chronic conditions: 42% of adults aged 65 and older took five or more prescription drugs in 2012, with the average number of drugs prescribed increasing from five at age 65 to seven at age 85.
What’s more, there’s a direct link between the number of medications taken by a patient and the risk of adverse drug reactions, NCPIE noted. Studies indicate a rise in the incidence of drug reactions from 6% in patients taking two medications a day to as high as 50% in patients taking five drugs a day.
The report also identifies behavioral, social, economic, medical, and policy-related factors that contribute to poor adherence in this patient population. Those include the complexity of the drug regimen, the need for patients to visit multiple pharmacies to fill different prescriptions, cost-control measures implemented by payers and health systems, poor communication between patients and clinicians, and the breakdown in provider communications during the transition to care from the hospital to the outpatient setting.
As highlighted in the report, the 10 priorities for action are the following:
1. Establish medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.
2. Establish the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the health care system and take their prescription medicines as prescribed.
3. Promote clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions.
4. Incentivize the entire health care system to incorporate adherence education and medication support as part of routine care for multiple chronic condition patients.
5. Eliminate the barriers that impede the ability of patients with multiple chronic conditions to refill their prescription medicines.
6. Reduce the cost-sharing barriers for patients by lowering or eliminating patient co-payments for prescription medicines used to treat the most common chronic diseases.
7. Accelerate the adoption of new health information technologies that promote medication adherence.
8. Establish medication adherence as a measure for the accreditation of health care professional educational programs.
9. Address multiple chronic conditions and optimal medication management approaches in treatment guidelines.
10. Stimulate rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.
To prepare this new report, in the fall of 2012, NCPIE began a new initiative called the Adherence Action Agenda, or the A3 Project, bringing together 22 organizations to identify the major gaps in current adherence efforts and provide input into creation by NCPIE of a new Adherence Action Agenda for the nation.
Members of the A3 Project include such pharmacy industry organizations as the National Association of Chain Drug Stores, National Community Pharmacists Association, Academy of Managed Care Pharmacy, Cardinal Health, McKesson, National Pharmaceutical Council, Merck and Pharmacy Quality Alliance.
Other A3 members include the Agency for Health Care Research and Quality, Center for Outcomes and Evidence, American Academy of Nurse Practitioners, American Academy of Physician Assistants, American Diabetes Association, American Heart Association, American Medical Association, Council for Affordable Health Coverage, AARP, Kaiser Permanente, National Consumers League, National Council on Aging, National eHealth Collaborative, NEHI, NIH Adherence Network and the National Heart, Lung and Blood Institute.
