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Medication Adherence a Problem for Many
By Chronis Manolis, RPh

Chronis Manolis, RPh

The issue of medication non-adherence is not, strictly speaking, a problem for the elderly. It was the late C. Everett Koop, a former surgeon general of the United States, who said, "Drugs don't work in patients who don't take them." He wasn't talking exclusively about just persons over 65.

No, medication non-adherence is a bigger problem than that. But it is an issue that certainly resonates with the elderly. Studies have shown that approximately half of all seniors who take at least one medication find adherence to be a challenge. And, it's been estimated that 20 percent of seniors who live in a senior community setting take 10 or more medications.

The failure to take drugs on time in the dosages prescribed is both dangerous for patients and costly to the health care system. And the reasons that people either don't take their medication or stop taking it before they should, is similar for young and old alike: It often comes down to a lack of understanding of a disease and a lack of respect for the condition.

Medication adherence impacts the cost of healthcare in many ways. According to the Express Scripts Drug Trend Report, $329 billion was spent on avoidable medical and pharmacy expenses as a result of patients not being adherent to medication treatments. Approximately 50 percent of all patients do not take their medication as prescribed, which results in increases in the overall cost of treating chronic conditions and increases the number of hospitalizations and emergency department visits.

There is no single explanation for why people do not take their medicine as directed by their physician. One reason is that if you have an asymptomatic condition (such as high blood pressure, cholesterol disease, and type 2 diabetes) taking medication may have no immediate effect on how you feel. And, when taking medicine does not make you feel better, some people don't understand why they need to take it. As a consequence, many do not.

Another issue is the cost of the medication, in particular for the elderly who may be on multiple medications. If there's no generic available it can be expensive and a patient may simply choose not to purchase it. Then, there's forgetfulness, which is a factor for older patients, but also for others as well. Some patients may avoid taking medicine because they fear the possible side effects. Other times, patients may not take medication because they do not believe that the medication is truly effective.

Solving the problem of medication non-adherence is complex because there is no "one size fits all" solution. A comprehensive, multi-pronged solution is needed to improve medication adherence.

Included in the effort solve the problem is the need to promote more conversation between physicians and patients concerning the importance of medication in an overall treatment plan. There may be a need for physicians to have a discussion with their patients about what expectations they have for taking medication. Is it to live longer, to have less pain, to reduce symptoms or some other reason? Are these realistic expectations?

There also needs to be a way to involve pharmacists more in the process. Pharmacists are uniquely positioned to reinforce the message above regarding the importance of medication. This can include encouraging patients to use their medication as prescribed and asking patients if they understand why they are taking a drug and if they understand the condition that it's being used for.

Health plans can play a role as well because they can determine if patients are refilling their prescriptions in a timely manner. Health Plan pharmacists can play a role by reaching out to non-adherent patients and by providing customized solutions and tools for patients to improve adherence. Additionally, health plan pharmacists can help triage specific patient adherence issues to other members of the health plan's team including care managers and health coaches to further assist.

For example, if cost is a factor, often less expensive generics are available. If forgetfulness is a problem, pillboxes or enrolling in refill reminder programs could work. Side effects can be eliminated by finding a substitute for the medication or changing dosing and/or frequency of the medication.

Chronis Manolis is Vice President of Pharmacy for UPMC Health Plan. He can be reached at manolisch@upmc.edu.

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