The expression goes, “always do what the doctor ordered.” Unfortunately, there are a few folks out there that do not adhere to this piece of sage yet cliché advice.

Medication adherence is an important part of treatment for a patient’s well-being and from a cost-savings perspective. A high level of adherence to a patient’s medication regimens can have profound impacts on their quality and length of life, their health outcomes, and overall health care costs.

But how do health care providers initiate and communicate this meaningful message to patients in an impactful, yet non-domineering fashion? The answer is medication adherence programs.

Medication adherence programs are defined as programs designed to improve the extent to which patients take medications as prescribed by their health care providers (Osterberg & Blaschke, 2006). These programs, if implemented correctly, can have an average savings of approximately $100 to $300 billion in annual health care costs, according to The American College of Preventative Medicine.

Implementation of such programs can be effective in improving outcomes for patients and reduce costs both at the patient and systemic level. However, to ensure that these programs have a design that is going to change a patient’s behavior in order to motivate them to implement change, we first need to isolate factors that cause or influence lack of adherence.

The first and most obvious barrier is medication cost. Patients who are confronted with financial difficulties when on a medication regimen are less likely to be adherent.

Lack of coverage, high out-of-pocket costs, and lack of access to care in general can potentially lead to patients attempting to offset the cost by resorting to alternative measures. Patients who cannot afford their medications may consume less of the prescribed dosage and frequency or may not even fill the prescription at all.

Misunderstanding is another barrier to consider. Patients need to be educated about their medications.

If a patient does not have a comprehensive understanding of the need for the medicine, the expected adverse effects (AEs), or how long it will take to see results, can quickly derail their desire and attentiveness to their prescribed therapies.

Misunderstanding becomes even more complicated if a patient is taking multiple medications. As the number of medications, dosing frequencies, and possible AEs increase, the likelihood of barriers that will influence a patient's willingness and capacity to initiate or remain adherent to their treatment will also increase.

Lack of symptoms is also something to consider. If a patient is not directly experiencing any symptoms that may be affecting their quality of life, they may feel a medication is ineffective and/or inessential.

If a patient cannot notice, understand, or appreciate the efficacy of their medication, they may not be totally averse to altering or even discontinuing their prescribed therapy altogether. Negative beliefs can be quite the stigmatizing barrier to medication adherence.

Patients may become anxious or fearful about how being adherent to a medication might impact daily life as they know it. Potential AEs, concerns about becoming dependent, and lack of communication between patient and health care provider can all negatively impact the beliefs of patients regarding their medications.

Yet another barrier to consider that is not to be understated is the prevalence of any existing mental health issues within patients. Depression and anxiety can most certainly demotivate patients to be adherent to their medications. A patient with a comorbidity is more likely going to have more complex issues with medication adherence and being diagnosed with a mental health issue is no exception.

As such, there are multiple barriers to consider when implementing and designing medication adherence programs. But no need to feel discouraged, there are effective strategies that can be used to overcome these barriers and improve adherence rates within a given patient population.

The first strategy is to identify and assess any and all patient-specific barriers. Health care providers who are proactive about conducting things such as needs assessments, disease state-specific segmentation, and using predictive analytics to identify patients’ behavioral trends, can gain a more thorough understanding of the patient's journey. Predictive analytics is particularly helpful in assessing patient-specific barriers.

Don’t see how? Consider the following.

Let’s assume that we are assessing a patient adherence to ensure sure that they don’t suddenly discontinue their medication. If we implement predictive analytics techniques, we can take into account aggregated claims data, eligibility information, and disease information about our patient. With all of these significant variables at our disposal, we can begin to form meaningful assumptions on how adherent a particular patient is to their medication and how at-risk they may be in lacking fidelity to their medication regimen.

The next strategy is meeting patients where they are. If your medication adherence program is truly patient-centric, you will have a much better chance of being impactful. Taking a deeper dive and more insightful look into the patient’s treatment journey will lead to better success. Developing an individualized care plan is crucial. It is important for each patient care plan to include predicted barriers, the patient’s values and motivations, and should conclude with a list of both short- and long-term goals.

Tools such as risk assessment and motivational interviewing are paramount for health care providers to gain an insightful view into the patient’s perspective. Early identification of patient needs leads to a customized approach as to the kind of education the patient will need and the type and magnitude of support required to best engage with that patient.

The patient-centric approach should leave patients feeling empowered about their participation in an adherence program. Furthermore, those patients need to be given all the tools necessary to effectively manage their own therapeutic outcomes.

The last strategy is the implementation of technology. This is important for obvious reasons, but an area that may not be so obvious is how technology can promote better and more frequent communication between patients and their health care provider.

A personalized support system with live outreach capabilities for patients to communicate with their physicians and pharmacists is essential. Again, in order to follow a patient throughout their treatment journey, there needs to be a certain degree of empathy and easily accessible communication platform between patient and provider to achieve the best possible outcome.

Text messaging, email, and phone calls all include a human element that enables the delivery of individualized content at the most appropriate time for a patient. It is clear that medication adherence is vital to improve outcomes and lower health care costs.

A successful medication adherence program will be heavily patient-centric with individual adherence goals, will use the technology capabilities available to draw meaningful conclusions, and promote healthy and frequent communication between patient and provider.

About the Authors
Nicole Kruczek, RPh, MPBA
, earned her BS Pharmacy from Temple University, School of Pharmacy and her Masters in Pharmacy Business (MPBA) degree at the University of Pittsburgh, Joseph M. Katz Graduate School of Business, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicine. She has spent the last 10 years as a Manager, Pharmacy Operations leading a high performing team of pharmacists and technicians.

Ryan Stept, MSc, earned his Masters of Science in Healthcare Administration from Saint Joseph's University and has recently earned his Masters of Pharmacy Business Administration program from the University of Pittsburgh. Currently, Ryan works for the University of Pittsburgh, School of Pharmacy, Program Evaluation and Research Unit as a program implementation specialist. Ryan’s work is primarily focused on the opioid epidemic and provides technical assistance to stakeholders across the commonwealth in their mutual efforts to reduce opioid death rates in Pennsylvania. Ryan strives to continue his work as a health care professional and utilize his in-depth understanding of the business of medicines.