Not taking medication as prescribed is an epidemic associated with poor health outcomes, and increased costs. You would think that a person who bothers to go see a healthcare professional, an endeavor requiring time and often money, would do as this professional says. But no. At least not always. Various estimates exist as to purposeful non-adherence, when patients make a decision not to take the meds. Some say that 32% of prescriptions never get picked up. It's worse for new subscriptions, especially for chronic diseases (because, honestly, who wants to start taking a medication they know they will never be off?), and worst for what specialists prescribe.
Amy Holthusen of Interstate Postgraduate Medical Association tells me of work they did, funded by a Pfizer educational grant, to assess needs around adherence. She tells me of the focus groups they held with physicians and the conclusions they reached, which revolve around ASK - discuss adherence pre-treatment, and ADAPT - inquire about it post or mid-treatment, and modify to suit the patient's needs. She shares with me the toolkit they have developed for healthcare professionals, and directs me to the online webinar at http://www.youtube.com/watch?v=BmrpmWpwxm0 or their website at www.ipmameded.org
In fact, she sounds like a real sweetheart, one who truly cares about adherence, which makes me feel really bad.
Because shamefully, disgracefully even, for someone who presumes to study adherence, I have been no less guilty of this than the next person. I would easily go see an orthopedic doctor over a shin pain, hear from them that I have no broken bones, receive some RX pills, then ditch the white piece of paper with the doc's scribbles on it, deciding I would rather suck the pain up rather than use chemicals. In any survey, I would join the culpable sad ranks of the non-adherent.
"Can I ask you something?" I venture, and confess. There, I got it off my chest, even if it costs me Amy's smile.
But her smile, audible even over the phone, does not go away.
"It's a communication problem," she says. "When giving a prescription the doctor should explain what the problem is, what the medicine will do, and what the patient thinks. If it seems like the patient is unhappy with the idea, the doctor should present alternatives." Such a dialog, had it occurred, including the legitimacy to raise concerns re-medication, would solve a large portion of my adherence issues.
"Why doesn't it happen?" I ask, blissfully absolved.
"No billing code," Amy explains. "Doctors do not get reimbursed for explaining all this to patients, but there is a billing code for prescribing medication."
And thus, for some of us, absolution - and a quick fix to the medical adherence problem - are a billing code away.
