Adherence Not the Only Factor in Optimal Medication Use

Numerous factors besides adherence influence effective medication management.

Although medication adherence is considered a crucial component of a patient’s health, a recent study found that adherence alone will not optimize medication use.

It is estimated that about half of all Americans have at least 1 chronic condition and that nonadherence costs the health care system up to $290 billion annually. This financial impact has caught the attention of health systems, payers, policy makers, and clinicians, placing the blame on the lack of medication adherence, according to a study published in the Journal of Managed Care & Specialty Pharmacy.

The National Quality Forum released a consensus report in 2010 on the standards for medication management. The report outlined and endorsed 19 measures for assessing the quality of medication management, 7 of which directly related to medication adherence.

Now the National Committee for Quality Assurance includes adherence measures in their Healthcare Effectiveness Data and Information Set (HEDIS) measures.

Furthermore, even more attention has been brought to adherence from health care reforms, such as the coverage of prescription drugs through Medicare Part D, as well as the expansion and enhancement of quality measures through the Affordable Care Act.

In order to evaluate the performance of Medicare Advantage plans and stand-alone prescription drug plans, CMS uses star ratings. In 2014, 3 adherence measures accounted for 11% of the overall star ratings for Medicare Advantage and 32% of the Medicare Part D star rating.

Since adherence is of great importance to star ratings, health plans and pharmacy benefit management companies (PBMs) have invested in programs that target adherence, the study noted.

Although the expansions are pursued with good intentions, the researchers noted they start with 3 critical assumptions: the medication is appropriately indicated for the patient and his or her medical condition; the medication prescribed will achieve the desired clinical effect at the prescribed dose; and the medication will not have any adverse effects. Furthermore, programs also assume that the medications have been prescribed.

Available research focuses primarily on medication adherence and rarely describes the application of a systematic and comprehensive approach to identify patient MRPs — an approach that ensures a patient’s medication is indicated, effective, and safe, and that the patient will take the drug as intended, according to the study.

To evaluate adherence, PDC is used to find whether a patient who received sufficient medication to cover 80% of days within a measurement period were considered adherent.

However, the best way to measure true adherence is to make sure that the medication is indicated, safe, and effective first, the researchers noted. If the medication is found to be ineffective or unsafe, then the patient should not be encouraged to be adherent until the correct changes are made to the medication, according to the study.

Medication Management Systems reviewed the occurrence of MRPs of more than 20,000 patients who were receiving CMM services.

The model first evaluated the medication for indication, efficacy, and safety, with adherence being the last category. The adherence category included affordability issues, patient understanding, and other issues that may affect compliance.

The evaluation revealed that for over 88,000 MRPS identified, only 14% were deemed to have problems where adherence was not the core issue. In fact, the biggest problem was the need for a medication that had not been prescribed for the patient, while the second most common problem was too low of a dosage, according to the study. Adherence was only the third most frequently identified MRP category.

Researchers believe that although they don’t have scientifically rigorous data, it should still shed more light on the significance of medication adherence when it is considered in the context of a comprehensive medication approach compared with the reliance of narrowly defined data sources like pharmacy claims data.