Sometimes I Takes My Medicine, And Sometimes I Just Sits

Despite all the health research in our universities and all the health segments on the local news, despite the calorie confessionals plastered on the menus at Mickey D’s and the health blogs interrupting our internet surf sessions, we are still a nation with a gap between current treatment success rates and those believed to be achievable.

According to an article that appeared in the “Annals of Internal Medicine” a few months back, we as a society have great difficulty with medication adherence. In fact, studies have shown that 20% to 30% of medication prescriptions go unfilled; and that number approaches 50% when the prescriptions are for medications that treat chronic disease. And while these statistics are interesting, the numbers illustrating the impact of non-adherence are just sobering: In the United States, lack of adherence is estimated to cause about 125,000 deaths, be responsible for at least 10% of all hospitalizations, and increase chronic disability. The annual monetary cost of non-adherence may be in the hundreds of billions of dollars in the United States.

Whose fault is this failure? Does fault mainly lie with the patient, the provider, or the system? Once this question is answered, how does one approach improving the situation, and does the cost of improving the situation make for a relatively healthier world? It certainly appears that chronic conditions such as depression, chronic pain, heart failure and asthma could be made less severe if adherence to the treatment regimen were improved.

Alas, adherence is a complex behavior, dependent on many variables:

• Patient factors (including age, race, sex, socioeconomic status, education and expectations).

• Condition and treatment-related factors (severity of disease and complexity of medical regimen).

• Healthcare provider characteristics (communication skills, empathy, and training).

• Treatment environment (drug coverage and access to clinical care).

An example of the impact of such variables on adherence: Patients in the United States are 2 to 3 times more likely to report cost-related non-adherence compared to their Canadian counterparts (who reap the rewards of a generally less expensive health care system). Indeed, the authors of this most recent study found that reduced out-of-pocket expenses improved medication adherence across all clinical conditions considered. Education with behavioral support also exerted a positive impact, as did reminders and interventions led by ancillary members of the health care team (e.g., pharmacists); however, these things can be labor-intensive. In contrast, reducing copayments can be a relatively easy way to improve adherence.

Although I am not sure the insurance companies will agree with the facility of lowering costs for any entity besides the insurance companies.

While there may not be cures for every disease, there are many proven treatments, some of which involve the simple act of swallowing a pill every day. Unfortunately, there are a large percentage of patients who, for one reason or another, have difficulty with adhering to what appears to be a simple intervention. Poor medication adherence results in poor outcomes, outcomes which include worsening health for the patient, and increased costs to society.

Specialists in the realm of behavior and economics will have to put their heads together in order to find the cure for medication non-adherence. Otherwise, any novel treatment or breakthrough by medical scientists will have little impact on a significant number of the population they are trying to help. And what a waste that is, for us all.