Study urges action to get patients to follow prescriptions
Patients who do not take their medications as prescribed pay a price in poorer health, more frequent hospitalizations, and a higher risk of death. Collectively, they also incur up to $290 billion annually in increased medical costs, according to a Boston-based health policy group that urges making the issue part of the national debate on overhauling health care.
From one-third to one-half of patients in the United States do not take their medications as their doctors intend them to, according to a report released this week by the New England Healthcare Institute. Some do not pick up or renew prescriptions, some do not take their medicine in the proper doses or at the right times, and others stop taking them altogether, the report says.
The reasons include cost, unpleasant side effects, confusion about the regimen, forgetfulness, language barriers, and feeling too good to need medicine.
“Much of the discussion in health reform today is really about providing better outcomes for patients, and ultimately, better health and medication adherence is a fundamental missing link to better outcomes,’’ said Valerie Fleishman, the institute’s executive director. “We believe that it’s critical that adherence be woven into the fabric of the health reform debate.’’
The report updates a 2001 analysis of the costs of poor patient medication adherence. It is based on seven systematic reviews of medical literature, as well as interviews with 16 health care organizations, insurers, drug makers, and technology companies. The work was paid for by this group of stakeholders, but the report was written independently, Fleishman said.
People who have chronic illnesses such as diabetes or high blood pressure are less likely to take their medications as intended than people being treated for an urgent problem.
One study cited in the report found that the death rate among diabetic and heart patients was 7 percent among patients who took their medications diligently, but 12 percent among patients who did not. Hospitalization rates showed similar gaps.
There has been little rigorous research on how to get more patients to take medications as instructed, but studies have pointed to some promising approaches, the report says. Simplifying drug regimens, which could mean prescribing pills to take once a day instead of four times a day, could help, particularly when patients are on multiple medications. Doing more to educate patients about their disease and their medications, especially as they leave the hospital, also appears to work.
Case managers and pharmacists can also play a role, some studies say. Lowering costs also can improve adherence.
The health care institute recommends some systemwide changes, such as revamping how health care providers are paid. Rather than reimbursing doctors based on the number of patients they see, they could instead be paid based on how well their patients are doing, the report says. Other recommendations include using health information technology to monitor what happens after an electronic prescription is transmitted to a pharmacy and to help patients manage multiple medication regimens.
Dr. Jerry Gurwitz, a University of Massachusetts Medical School geriatrician, said keeping patients on medications they need is a pressing problem, especially among older people who live alone and might suffer from cognitive impairment. He was not involved in the report. “I think any person who is practicing medicine is going to say it’s one of the biggest challenges and frustrations of providing care to patients right now,’’ he said.
