We’ve got an adherence problem. What are we doing about it?

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Medicines adherence needs a multi-pronged approach, writes Tal Rapke

According to a 2003 report by the World Health Organization into medication adherence, approximately 50 per cent of patients with chronic illness don’t take their medications as prescribed. This poor adherence to medication leads to wastage, disease progression, increased morbidity and death, increased burden on medical resources, and is estimated cost approximately $100-$300 billion per year.

It can be easy to write this issue off as the patient’s responsibility, but there are myriad factors that contribute to non-adherence. The medication-taking experience is a complex interaction that involves patient, physician, and the broader healthcare system. All these components need to be functioning together correctly for a successful health outcome.

Given that increased adherence would not only greatly improve patient outcomes but also save the healthcare sector billions of dollars, addressing this pervasive issue should be a priority for the industry. But what really causes it, and how can we improve our approach?


The patient

There are several patient-related factors that can contribute to non-adherence, including a lack of understanding of their disease and a lack of involvement in the treatment decision-making process, which can leave a patient feeling confused and powerless.

Sometimes, non-adherence isn’t a deliberate decision by the patient, but an unintentional side effect due to capacity and resource limitations; for example, problems physically accessing prescriptions and pharmacies, a prohibitive cost, or competing demands on a patient’s time.

Literacy is also a large contributing factor—in the US alone, close to 90 million adults have inadequate health literacy, which puts them at greater risk of hospitalisation and poorer clinical outcomes. Beliefs and attitudes about health and treatment effectiveness, together with previous experiences with pharmacological treatments also affect their level of adherence.


The physician

Non-adherence often stems from communication problems between patient and physician. Many physicians can contribute to non-adherence by prescribing complex drug regimens and failing to explain the benefits and effects of the specific medication—in fact, studies report that 40-60% of patients could not correctly report what their physicians expected of them 10-80 minutes after they were provided with the information.

Physicians can also fail to appropriately consider or consult with the patient in terms of the financial burden of the medication, particularly in chronic cases where the medication will be a long-term cost.


The healthcare system

Fragmented healthcare systems create barriers to adherence by limiting cross-centre coordination and the patient’s access to care. Prohibitive medication costs are also a large contributing factor to non-adherence, as is limited health technology, which prevents physicians or pharmacists from easily accessing patient information from different venues.

This can affect timely medication refills, and patient–physician communication.


The solution

There are a number of ways we can approach this widespread issue. The first is to empower the patient to feel engaged and motivated to manage their disease and medications. To start, physicians should encourage a ‘blame-free’ environment so patients can speak openly about their medication-taking behaviour, and assess health literacy to ensure that patients understand the key information about their medication.

Involving the patient in treatment decisions is also critical; for example, a patient may be more likely to adhere to a medication regime if they have chosen the time of day they need to take their medicine.

The opportunity to utilise new technologies to combat non-adherence cannot be overstated—I firmly believe prescription management technology is the key to minimising wastage and addressing sub-optimal management of prescription medications. It can also empower the patient by giving them full control over their healthcare data.

We are currently rolling out a new application across five test sites in Australia that has the potential to greatly improve medication adherence.

Alongside digital tools such as Scalamed, physicians can also provide traditional medication adherence tools like pill boxes, calendars or schedules that specify the time to take medications.

Addressing medication non-adherence requires a concerted effort by healthcare professionals across all patient touchpoints. We need to focus on educating and empowering the patient, communicating effectively, and harnessing the power of prescription management technology to drive behavioural change.





Tal Rapke is the founder of ScalaMed.

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