Patients who do not take their medications as prescribed by their physicians are costing the American healthcare system as much as $290 billion annually in avoidable medical spending—or about 13% of total national healthcare expenditures, according to a new report from the nonprofit New England Healthcare Institute (NEHI) in Cambridge, MA.
Overall, an estimated one-third to one-half of all patients in the United States do not take their medications as prescribed by their physicians. These adherence problems are being generated in part by growing numbers of individuals with chronic disease: Adherence rates have been found to be lower among patients with chronic conditions than among those with acute conditions, according to the report, Thinking Outside the Pillbox: A System wide Approach to Improving Patient Medication Adherence for Chronic Disease.
"There are enormous costs to non-adherence," said Valerie Fleishman, NEHI's executive director. "First and foremost are the human costs of poorer health."
Among all patient groups, the risk of hospitalization due to poor health outcomes increases—resulting in higher excess costs. For example, among patients with diabetes, those with lower levels of adherence have nearly twice the total annual healthcare costs of those with high levels of adherence ($16,498 versus $8,886).
"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," Fleishman said. "We believe that adherence needs to be woven into the fabric of the health reform debate in several different ways."
The NEHI report cited several innovations that show promise in dealing with adherence, including improving drug regimens, reducing cost barriers, and tailoring programs to individual patients. From these areas, NEHI identified four of the more promising solutions for public and private policymakers to examine in addressing patient medication adherence as part of health reform efforts:
Creating healthcare teams. While physicians play key roles in improving medication adherence by their patients, the issue could be too complex for physicians alone—leading to calls for additional support through the creation of care teams that incorporate nurses, care managers, pharmacists, and other clinicians. This can be either within or outside a physician’s practice. These teams increase the number of “touchpoints” for patients--providing repeated checks on their adherence as they move through the healthcare system, Fleishman said.
Patient engagement and education. Counseling by primary care providers and pharmacists can ensure that patients understand their diseases and how their medication can improve their condition. This can prove critical to motivating patients toward sustained adherence.
Payment reform. Realigning reimbursement incentives away from rewarding volume and toward rewarding good outcomes could encourage providers to strive for improved outcomes by way of improved adherence, as would performance based or global service reimbursements, the report noted. In the long run, payment reform would encourage providers to invest in resources, such as counseling services, that would improve patient outcomes by increasing medication adherence.
Using health information technologies. More secure and reliable information flows using technologies, such as electronic health records, e prescribing, and clinical decision support systems, could ensure that complete and accurate medication data are shared among patients, prescribing physicians, and pharmacists.