New tools and platforms can help pharmacists to support patients.
A recent New York Times
lifestyle article featuring technology solutions for the mundane tasks of our lives highlighted a digital talking pill bottle with a light-up cap. Its purpose is to remind you when it’s time to take medicine and to order a refill when you run out.
No longer relegated to the inside pages of AARP The Magazine
, medication adherence has gone mainstream, front and center, as we pursue the value equation of cost over quality, post health care reform. Medication nonadherence is a big health and cost problem. Half the 3.2 billion annual prescriptions filled in the United States are not taken as prescribed. Fewer patients with chronic health conditions take their medications as prescribed. The price is high—$105.4 billion in avoidable US health care costs as a result of nonadherence.1
Adherence is generally defined as taking medicine the way the doctor prescribed it—the right amount, at the right time, and for the length of time prescribed. As awareness of patient nonadherence and its ramifications increase, most of the consumer technology solutions that have emerged have focused on forgetfulness and seek to resolve the problem through behavioral aids via reminders to pick up filled prescriptions, take medicines, and order refills. The reminders come in the form of text messages, e-mails, smartphone apps, interactive voice reminders, and prizes for self-reporting adherence success.
Reminders make sense if we assume that the patient is completely on board with the course of treatment and, from time to time, simply forgets. But reminders alone fail to address (1) the larger issue of why people don’t take their medicines as prescribed and, perhaps more importantly, (2) the goal of having a common understanding of why they were prescribed and, ultimately, what the prescriber is trying to accomplish in partnership with the patient.
One of our pharmacy customers recently shared an example of a patient routinely returning to the emergency department for treatment of anxiety. The pharmacist identified a pattern: the hospital visits consistently fell a few days shy of the refill date on the patient’s Xanax prescription. Our customer, whose pharmacy includes an aggressive adherence and medication management program, reached out to the patient, engaging her in order to understand the problem. The patient couldn’t afford transportation to the pharmacy, so she was trading a handful of Xanax for a ride. The solution was home delivery. The patient hasn’t returned to the hospital since. These patient-centered types of solutions are not resolved through a one-size-fits-all technology.
Why People Don’t Take Their Medications
Reasons for not taking medications are as complex and individual as each patient. Cost clearly influences adherence, with more people taking medicines when insurers eliminate or reduce prescription co-payments. But eliminating out-of-pocket costs alone is not enough, according to a recent study showing nonadherence rates of up to 40% among patients covered by health plans with no prescription co-payments.2
Other factors influencing a patient’s decision to take medicines as prescribed include religious and cultural beliefs; family dynamics such as a negative outcome for a relative who took a similar medication; health literacy; financial constraints; transportation; geography (where they live); and lack of coordination of care across the patient’s health team.
We know that if patients take their medications, it leads to better health, which ultimately requires less care. Achieving medication adherence means engaging with patients along their journey and aligning pharmacy services and support with their lifestyles. As part of our technology development, we conducted a series of focus groups among individuals aged 30 to 60 years and 60 years and older who either take multiple medicines daily or are caregivers for someone who does. When participants talked about “forgetting” to take their medicines, it was often the result of changing their routines for travel, eating out, or needing to take a pill with food at a time when eating wasn’t convenient.
As important as understanding why people don’t take their medications is the need to understand what motivates some to stick with a treatment plan. When we asked participants why they adhere to their treatment plan, we heard the following reasons: to be independent, to be able to work and continue enjoyable activities, and to be there for others who are important to them. These are among the reasons why pharmacists are seeing considerable success when they incorporate pouch packaging into their adherence programs for patients taking multiple medications. Packaging the medicines by time of day gives patients independence—it’s easier to tuck a pouch into a pocket or purse than to lug a bag filled with pill vials. And patients say it helps reduce the stigma of being viewed as a person with an illness; in fact, it helps them feel less sick and empowers them to get on with their lives. Since patients typically frequent pharmacies more often than any other type of health care facility, the “high-touch” environment of the pharmacy is becoming a popular place for reinforcement and review of medication action plans. What better place to close the touch gap?