Let's Pay Attention to Medication Use in the Reform Debate

HealthLeaders Media Staff, August 27, 2009

In the midst of the healthcare reform debate, one topic seems to be missing: Addressing the problem of patients who fail to take their medications as prescribed by their physicians.

According to a study I reported on earlier this month from the non-profit New England Healthcare Institute (NEHI), this problem may be more widespread than expected. More than a third to a half of all patients in the U.S. are not taking their medications. The subsequent cost to the American healthcare system: approximately $290 billion annually in avoidable medical spending.

"In this era where we're looking both at improving patient outcomes and in reducing overall healthcare spending, improving adherence is really a significant link to [addressing] health reform," said Valerie Fleishman, NEHI's executive director.

Many barriers, NEHI noted, exist blocking better medication adherence—cost, side effects, challenges of managing multiple prescriptions, patients' understanding of their disease, forgetfulness, cultural and belief systems, imperfect drug regimens, patients' ability to navigate the health care system, cognitive impairments, or a reduced sense of urgency because of a lack of symptoms.

In many instances, adherence rates were found by NEHI to be lower among patients with chronic conditions than among those with acute conditions. Also, studies have shown that the length of time a patient continues to take a prescribed drug could be correlated with a drop in adherence shortly after a drug is prescribed.

For instance, among a large group of patients with coronary artery disease, over 25% of patients discontinued drug therapy within 6 months. Another study of patients receiving statin drugs found that while adherence was nearly 80% in the first three months of treatment, adherence dropped to 56% within 6 months; only one in four patients had an adherence level of 80% or greater after five years.

And different medications may have their own set of problems. For instance, in a study published this month in Population Health Management, many patients prescribed opioids for chronic pain were unlikely to be taking their medicine as prescribed.

Among 938,586 urine toxicology tests conducted on over 500,000 patients prescribed chronic opioid therapy, analysis showed that 38% of patients had no detectable level of their prescribed medications; 27% had a drug level higher than expected; 15% had a drug level lower than expected; 11% had major illicit drugs such as cocaine or methamphetamines detected in their urine; and 29% had a medication in their system that the doctor was likely unaware of.

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