Coronavirus fears drive medication adherence ups and downs.
This article was originally published June 10, 2020 on PSQH by Megan Headley.
The cost of poor medication adherence is tremendous—nearly $177 billion each year in direct and indirect healthcare costs—but the cost of nonadherence during the COVID-19 pandemic has the potential to be much higher. Medication nonadherence can drive up otherwise avoidable hospital admissions, burdening healthcare systems already struggling to care for coronavirus patients and putting other patients at greater risk of contracting COVID-19.
Since medication nonadherence already accounts for 50% of treatment failures, approximately 125,000 deaths, and up to 25% of hospitalizations each year, it has become more important than ever for physicians, pharmacists, and insurance companies to work together to keep patients on their prescriptions.
An old problem presents a new challenge
The negative impacts of medication nonadherence are well documented, including poor health outcomes, additional illnesses, avoidable hospital admissions, premature deaths, and billions in unnecessary healthcare expenditures each year. Barriers to adherence range widely as well, from high cost and inconvenience in accessing prescriptions to negative side effects and poor communication between providers and patients.
Today, however, there’s a new barrier to add to the list: fear. People have avoided healthcare locations—from emergency room visits to routine checkups—to stay out of contact with patients who may have the coronavirus. For example, a May 2020 study from researchers with the CDC found that vaccinations for children have dropped significantly since the start of the COVID-19 pandemic, prompting concerns of forthcoming outbreaks of vaccine-preventable diseases. Measles vaccinations for children under age 2 dropped by half from March 13 through March 23, while vaccinations for children ages 2–18 dropped from 2,500 per week pre-pandemic to fewer than 500 per week. Researchers attribute the decline to parents’ concerns of exposing their children to COVID-19 during visits to healthcare providers.
However, routine healthcare, including vaccinations and medication management for chronic diseases, may be even more important now to maintain patient health and keep people out of hospitals. Addressing these concerns with open communication and documented safety procedures will be critical in bringing people back to the physician’s office for routine care.
On the other end of the spectrum, fear is in some cases driving up medication adherence. A study from researchers with the American Academy of Allergy, Asthma & Immunology, published in The Journal of Allergy and Clinical Immunology: In Practice, found a 14.5% increase in adherence in controller inhaler use between January and March 2020, at the start of the COVID-19 pandemic in the United States.
An analysis of controller inhaler use for 7,578 patients using Propeller Health, a digital platform that employs electronic medication monitors to track inhaler use and send alerts to patients about missed doses, saw that in the last seven days of March 2020, more than 53% of patients achieved 75% or greater medication adherence, up 14.9% from the first seven days of January. The data indicated similar medication adherence increases across all age groups, with older patients showing an overall higher baseline adherence.
“We are encouraged by the increase in patient adherence to their medications for asthma and COPD, which is critical to avoiding symptoms and keeping patients out of the hospital during this pandemic,” commented author Leanne Kaye, PhD, MPH. “This research further supports that digital health tools can improve adherence and provide insight into patient well-being between office visits.”
Reexamine communication strategies
For both patients and providers, awareness of solutions to medication barriers is a critical first step in improving adherence. Because many patients are reaching out less as a result of social distancing, providers will need to take the first step in building this awareness.
“Patients are feeling more isolated,” says pharmacist Heidi Polek, RPh, strategic program manager with DrFirst, a technology company focused on providing doctors, pharmacists, and patients with tools that help them stay connected. “Their daily activities have been disrupted. They can’t just walk into a pharmacy or their doctor’s office anymore.” However, patients can still communicate with these professionals through telehealth solutions and automated medication alerts.
The DrFirst technology solution alerts patients when scripts are written or ready for pickup, helping maintain communication between providers and patients. Those simple reminders can make a big impact. As Polek explains, a company solution that sends prescription information from the doctor to the patient, with a reminder of what the prescription is for and why it’s important to take it, has prompted a 6% boost in medication adherence for clients.
The way providers ask about medication adherence can also have a big impact. In an episode of the AMA’s Moving Medicine podcast, Marie T. Brown, MD, a geriatric and internal medicine specialist at Rush University Medical Center in Chicago, commented, “Patients really have been encouraged to hide their nonadherence.”
From Brown’s perspective, physicians tend to chastise patients when they learn of nonadherence. After all, physicians see medication adherence as the patient’s responsibility in the mutual work of improving the patient’s health. “Because of their social desirability, patients want to say yes when the doctor that they’ve known for a long time, or even a new doctor, asks them if they’re taking their medicine,” Brown said.
By changing the conversation to acknowledge that medication adherence is difficult for lots of people and for lots of reasons, patients get a safe space to begin to explain their specific barriers. This conversation must evolve at every patient interaction, Brown added. “If one person on the team understands why a patient has a reasonable reason for not taking their medicine and respects that reason and then can tailor the message, but if not everybody on the team understands it, then the patient will get mixed signals.”
Reduce cost and access barriers
Since the start of the COVID-19 pandemic, there has been ample communication encouraging consumers to fill prescriptions early or in larger quantities in order to limit trips to pharmacies.
“Luckily, insurance companies have relaxed some of their rules on when patients can get prescriptions refilled,” Polek says. “We’re encouraging patients to reach out to their physician and their insurance company to see what options they have.”
Data from AllazoHealth, an AI and machine-learning company that focuses on driving behavioral changes in patients through personalized and proactive intervention, indicates this encouragement and relaxation of insurance rules is working.
Upon reviewing a subset of its clients’ data to better understand the effects on medication access after the spread of COVID-19 in the United States, AllazoHealth researchers found that the percentage of prescriptions filled more than a week before their due date increased 18% within one week. The company concludes that the surge in early medication refills was motivated by patients’ fears of being unable to access their medications for an undetermined period of time. This may have been compounded by news reports warning of potential drug shortages due to pharmaceutical demand and supply chain disruptions.
However, the individuals stocking up on medications may already have been aware of the importance of medication adherence. After all, getting the medication is only part of the access problem. Cost is yet another barrier.
Polek notes that DrFirst is pushing physicians to acknowledge this issue early in medication conversations through its tool that lets providers see the cost of a prescription before they write it. “It gives them a great opportunity to speak to that patient at the point of encounter and make sure the patient can afford their medication,” she says.
DrFirst also works to send patients secure messages about cost-saving alternatives to their prescription. “If that isn’t everything the patient needs, doctors and pharmacies can help find local organizations to help or connect patients to their insurance company who might be able to help. We’re also seeing programs from manufacturers for patients who are in need,” Polek adds.
Continue to strengthen connections
Polek believes a large part of the solution to medication nonadherence will come through awareness of the options available for connecting patients to needed medications. However, medication adherence during and after the pandemic will also depend upon providers’ awareness of their role in addressing patients’ potential barriers to medication access. The COVID-19 pandemic has challenged more people than ever in filling their prescriptions. But it’s also driving new strategies for connecting with patients, ones that have the potential to open up new chains of communication.
“It’s important that everybody stay connected,” Polek urges. “We’re here as a company to help keep that circle of care connected, and I just want to remind people to reach out: to your doctor, your pharmacist, your family, your friends. That’s the most important thing to do today.”
The flipside is also true: It’s more important than ever that clinicians, pharmacists, and other care providers reach out to patients with chronic problems to improve patient care and reduce the ongoing burden on our health system.
Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at email@example.com.
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