Barriers and Facilitators to Medication Adherence

Minneapolis—Patient adherence to prescribed medications has been well documented as an important issue in containing overall costs. Researchers recently conducted a survey of adherent and nonadherent patients to aid in understanding the factors relating to medication adherence. They reported results of the survey at a poster session at the AMCP meeting. The poster was titled Barriers and Facilitators for Medication Adherence. The survey was designed to determine factors that act as both facilitators and barriers to medication adherence for patients with diabetes and asthma. The researchers identified members of a health plan who were >18 years of age and had at least 2 prescription fills for >28 days supply from January 2007 to March 2009. The survey focused on medications to treat depression, hypertension, hyperlipidemia, diabetes, asthma/chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis. Diagnoses identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes were merged with pharmacy claims. Using medication possession ratio to calculate adherence, the researchers determined that adherence was lowest among patients with diabetes and patients with asthma. Five hundred patients with each condition were selected to be surveyed; 50% of each group was adherent and 50% was nonadherent. The ASK-20 questionnaire was the basic tool used for the survey; the researchers added questions directly related to facilitators and barriers to adherence. ASK-20 consists of 20 clinically actionable items representing multiple factors that affect medication adherence. Survey results revealed that approximately 30% of the patients forget to take their medications, 16% do not refill their prescriptions on time, and 22% reported taking more or less than prescribed in the past month. The most frequently mentioned barriers were an irregular schedule, the requirement to take medications with food, and being too busy to refill prescriptions. The most frequently reported facilitators were taking medications at the same time each day and using a weekly pill reminder. The researchers noted that they are currently analyzing open-ended comments to identify additional barriers and facilitators; they are also planning to conduct subgroup analyses (by age and sex). In conclusion, the researchers commented that “building routine into medication-taking behavior appears to be a key factor for adherence. Finding ways to help patients in this effort is an important consideration for health plans to promote adherence. This study will help guide discussion within the health plan’s pharmacy team to enhance adherence and maximize the benefits of prescribed therapies.” This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.