July 31, 2018

Enabling Patients to Stick to their Medication

Investing in medication adherence improves health outcomes and health system efficiency

OECD provides some key figures on medication adherence:
Poor adherence is estimated to contribute to nearly 200 000 premature deaths in Europe per year. Patients with chronic diseases are particularly vulnerable to poor health outcomes if they do not adhere to their medications. Mortality rates for patients with diabetes and heart disease who don’t adhere are nearly twice as high as for those who do adhere.
It is estimated to cost EUR 125 billion in Europe and USD 105 billion in the United States per year in avoidable hospitalisations, emergency care, and outpatient visits.
The three most prevalent chronic conditions – diabetes, hypertension, and hyperlipidaemia – stand out as the diseases with the highest avoidable costs, for
which every extra USD spent on medications for patients who do adhere can generate between USD 3 to 13 in savings on avoidable emergency department visits and inpatient hospitalisations alone.
I'm dubious about the exact figures, anyway if you imagine that it is half ow what the say it would be a lot. Systematic reviews say that non-adherence is 15%. This is a hot topic and the ways to tackle are known.
Acknowledge: Medication non-adherence harms health and increases healthcare costs. The first step for the relevant stakeholders is to acknowledge that this problem exists and to adequately recognise its main drivers. Medication adherence needs to move up the policy agenda in order to raise awareness of the problem and mobilise adequate responses.
Inform: Few countries systematically monitor adherence. Routine adherence measures as well as adherence-related quality and performance indicators should be encouraged in order to improve health system effectiveness and efficiency.
Incentivise: Changes in financial incentives for providers and patients are essential. Shifting to payment systems that reward providers for the quality of patient outcomes would provide strong motivation to improve adherence. Medication adherence could also be considered as a measure for performance based contracts with pharmaceutical companies. Where patients’ co-payments for chronic medications exist, their reduction or removal should be considered to reduce financial barriers.
Steer and Support: The adherence process begins with a patient and a prescribing clinician and a dispensing pharmacist who should all be supported by other health system stakeholders. Payers/system designers can develop IT systems that facilitate optimal prescribing and patient-clinician communication or renewing prescriptions by patients. Educators have a role in equipping health professionals with skills in managing adherence such as person centred communication, shared decision-making, and socio-cultural competencies.