Pharmacists’ Viewpoints and Suggestions to Improve Medication Adherence in Patients

Adherence to therapy is an integral component of a treatment plan and in attaining improved clinical outcomes; however, nonadherence frequently occurs for various reasons. Nonadherence may be classified as unintentional or intentional. Examples of factors documented in that literature that may contribute to nonadherence include patient forgetting to take doses as prescribed, anxiety fears/concerns about potential adverse effects, patient’s perceptions or beliefs about the need for therapy and/or its efficacy, failure to obtain the prescribed medication, discontinuing therapy without prescriber consent, cognitive impairment, complex medication regimens, poor understanding about therapy and administration instructions, inability to afford medications and inadequate patient–provider communication and follow-up about selected therapy.^1-3

In a publication by the American Heart Association, the author indicated that an estimated 3 out of 4 Americans do not take their medications as directed.⁴ Additionally, data from clinical studies revealed that the incidence of medication adherence is often much lower among patients with chronic diseases, especially those with multiple chronic comorbidities. Examples of chronic conditions with the greatest rates of nonadherence to medication include diabetes, hypertension, and depression.^3-7 Some publications report medication nonadherence affects an estimated 40% to 50% of patients with diabetes or hypertension.^3-7 Literature indicates that annually in the US, nonadherence to medication accounts for an estimated 125 000 avoidable deaths, 10% of hospitalizations, and between an estimated $100 to $289 billion in avoidable health care costs.3,8,9 The FDA indicates that 20% to 30% of prescribed medications are never filled, medications are not taken as directed 50% of the time, and some patients take less or discontinue medications for chronic disease after at least 6 months of therapy.¹⁰

Findings from a recent retrospective cohort study highlight the positive impact of adherence on clinical outcomes. In this study, researchers used the Pharmacy Quality Alliance (PQA) proportion of days (PDC) adherence metric days covered (PDC) for non-infused biologic medications to treat rheumatoid arthritis (RA) and sought to explore correlations between this PQA PDC adherence metric and total medical cost, hospitalizations, and length of stay (LOS) for patients with RA. Results revealed that RA patients adhering to their non-infused RA biologic medication were more prone to lower medical costs, odds of hospitalization, and LOS.^11,12

In a press release, Francis Staskon, PhD, principal analyst of Health Analytics, Research & Reporting at Walgreens, and lead author of the study, stated, “Research found that adherence to a non-infused RA biologic can lead to lower medical costs, odds of hospitalization, and LOS after controlling for many other influences on these outcomes. In addition, the findings support the PDC-RA methodology presented about calculated adherence rates used for reporting requirements."¹² Additionally, Renee Baiano, PharmD, CSP, clinical program manager for Alliance Walgreens Pharmacy, and an author of the study, stated, “The research findings underscore the importance of patients remaining adherent to their therapy.” Baiano also says specialty-trained pharmacists should take a proactive approach to encourage medication adherence.¹² "Identifying barriers to adherence and educating patients on the importance of taking their medication can increase the patient's chance at disease improvement," declares Dr. Baiano. "Whether it's helping the patient take their medication the right way or notifying their prescriber about a new adverse event, a specialty pharmacist can play a vital role in helping patients manage their condition."¹²

Pharmacist’s Viewpoints and Suggestions

Retail pharmacist stated, “After almost 34 years in practice, I always try to remind patients, especially when dispensing a new prescription for a chronic illness such as diabetes or CVD, about the importance of being adherent with medications to slow or halt disease progression end encourage patients to always call the pharmacy or their PCP if they have any concerns. I also try to encourage patients to take an active role in their care, which often improves adherence, especially when patients see positive results. Patient education about diseases and medication, setting realistic treatment goals and patient expectations are critical to improving adherence.”

Retail pharmacist stated, “Many patients have issues paying for medication even with insurance and are unaware of the various manufacturer savings programs with zero or minimal out-of-pocket costs. Informing patients about those makes a big difference in patients deciding to take medication. I recently had a patient who would not start diabetes medication because of the costs and changed her mind when she was provided information about the cost-saving program. It’s been a year, and her diabetes is well controlled because she has access to medication that she would not have been able to afford otherwise.”

Hospital pharmacist stated, “My staff and I encountered a patient hospitalized multiple times because he kept forgetting his medications, and his blood pressure and diabetes, among other conditions, were poorly controlled. The patient was frustrated with the number of daily medications and doses for several chronic conditions. To improve adherence, we worked with his PCP and made suggestions about medications that had long-acting or once-a-day dosing options that made a difference. The patient was happy about the once-a-day dosing options, which hopefully improved compliance.”

Retail pharmacist stated, “For patients with complex medication regimens, in collaboration with prescribers, I always suggest either simplifying regimens if feasible, using reminder apps or pill boxes to ensure that patients are taking doses on time and also encourage patients to set up automatic refill reminders for maintenance medication or 90-day refills if practical, so they can always have a supply on hand. I think it is also vital that patients understand the consequences of non-adherence, as this gives patients more incentive to adhere to a recommended treatment plan.”

References

1. Baryakova TH, Pogostin BH, Langer R, et al. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov. 2023;387–409. doi:10.1038/s41573-023-00670-0
2. Bae SG, Kam S, Park KS, Kim KY, et al. Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community. Patient Prefer Adherence. 2016;10:1979-1989. doi:10.2147/PPA.S114529.
3. Kleinsinger F. The unmet challenge of medication nonadherence. Perm J. 2018;22:18-033. doi:10.7812/TPP/18-033
4. Medication Adherence - Taking Your Meds as Directed. www.heart.org. https://www.heart.org/en/health-topics/consumer-healthcare/medication-information/medication-adherence-taking-your-meds-as-directed
5. Lam WY, Fresco P. Medication adherence measures: An overview. BioMed Res Int. 2015;2015(217047):1-12. doi:10.1155/2015/217047
6. Lehmann A, Aslani P, Ahmed R, Celio J, et al. Assessing medication adherence: Options to consider. Int J Clin Pharm. 2014;36:55–69. doi:10.1007/s11096-013-9865-x
7. Hamilton JE, Blanco E, Selek S, Wirfel KL, et al. Patient and provider perspectives on medication non-adherence among patients with depression and/or diabetes in diverse community settings – A qualitative analysis. Patient Prefer Adherence. 2022;16:1581-1594 doi:10.2147/PPA.S328785
8. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97. doi:10.1056/nejmra050100
9. Viswanathan M, Golin CE, Jones CD, Ashok M, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):785-95. doi: 10.7326/0003-4819-157-11-201212040-00538
10. FDA. Why You Need to Take Your Medications as Prescribed or Instructed. U.S. Food and Drug Administration. Published February 16, 2016. Accessed November 1, 2023. https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed
11. Staskon F, et al. Rheumatoid arthritis (RA) and non-infused biologics: adherence, healthcare cost and utilization. Presented at the National Association of Specialty Pharmacy 2023 Annual Meeting and Expo (NASP 2023), Sep 18-21, Grapevine, TX.
12. Pharmacy AW. Walgreens, AllianceRx Walgreens Pharmacy Study of Non-Infused Biologics in Rheumatoid Arthritis Treatment Underscores Importance of Medication Adherence. www.prnewswire.com. Published September 20, 2023. Accessed November 1, 2023. https://www.prnewswire.com/news-releases/walgreens-alliancerx-walgreens-pharmacy-study-of-non-infused-biologics-in-rheumatoid-arthritis-treatment-underscores-importance-of-medication-adherence-301931160.html