Medication Adherence among Patients with Diabetes in a Managed Care Setting

Minneapolis—It is estimated that only about 50% of patients in the United States take their medications as prescribed. Poor adherence to medication regimens has been shown to have an impact on healthcare costs; approximately $150 billion in direct costs each year can be attributed to lack of patient adherence. Poor adherence is associated with an estimated 10% of annual US hospitalizations and as many as 40% of nursing home admissions. Poor adherence also contributes to an additional $2000 per year per patient in costs of visits to physicians’ offices. At a pharmacy partnership briefing session at the AMCP meeting titled An Opportunity to Improve Quality of Care: Physician-Related Variations in Medication Adherence among Diabetes Patients, representatives of a multiyear collaborative health initiative in Ohio presented data on efforts to improve adherence among a managed care population. Aydin Sekill, MBA, manager, analytic consulting services, CVS Caremark, and Bruce Sherman, MD, FCCP, FACOEM, director, Employers Health Coalition of Ohio, were the presenters. The presenters began with an overview of the problem of poor medication adherence by outlining some of the factors that contribute to poor patient adherence, including cost of medications, lack of health literacy, presence of comorbid conditions, medication dosing schedule, side effects, lack of perceived benefit from the medication, motivation, clinician relationship, and clinician continuity and follow-up. They presented data from a 2005 study [Sokol MC et al. Med Care. 2005;43(6):521-530] demonstrating that patients with diabetes who were the most adherent had total costs that were 47% lower than patients who were the least adherent. However, he continued by noting that adherence rates are also affected by other factors, such as patient education about the benefits of the prescribed regimen, memory aids such as daily and weekly pill boxes, and refill adherence incentives. Noting the importance of physician–patient relationships, Mr. Sekill and Dr. Sherman presented data from a 2009 study [Ann Intern Med. 2009; 150(5):325-335] that demonstrated that physician-connected patients are more compliant with care and more adherent to their medication regimens compared with patients who are practice-connected. The speakers continued by presenting data from studies conducted in other parts of the United States, including a retrospective study on medication adherence in patients with diabetes. In that study, reported at a poster session at the October 2010 AMCP Educational Conference, researchers found that adherence in the study population was suboptimal and participants showed noncompliance with other American Diabetes Association recommendations. In conclusion, the speakers summarized by noting that, “physician–patient interactions can have an impact on medication adherence; clinician identification and intervention to improve patient-specific adherence rates may be highly cost-effective; further research is necessary to better understand factors contributing to medication adherence differences among clinicians; and analysis supports the need to explore ways to educate both prescribers and patients on the importance of medication adherence and compliance to disease management guidelines.”