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Medication adherence fundamentals and AI solution to combat non-adherence – Part 1

Yashodeep Sengupta
   

What’s all the buzz about medication adherence?
— A techie’s primer

Jim works in the health information technology (healthtech) industry. His latest assignment requires him to do some digging around in the field of medication adherence with an aim to zero in on a proven solution that can benefit his organization.

What’s a good starting point for Jim? You guessed it right – Jim begins by understanding the fundamentals of medication adherence. Here’s a sneak peek into his notes:

What is medication adherence?

The World Health Organization (WHO) defines medication adherence as ‘the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider’.

Some related key terms

Medication compliance: The extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen.

Concordance: The extent to which patients are successfully supported both in decision-making partnerships about medicines and in taking their medicines.

Persistence: The length of time between initiation and the last dose, which immediately precedes discontinuation.

What is medication compliance?

Medication adherence is not the same as medication compliance. According to a well-cited article published in The New England Journal of Medicine, medication compliance is the passive act of the patient to follow the provider’s orders. A therapy-based understanding between the patient and the provider is missing in this case. Whereas, medication adherence is the extent to which patients take medications as prescribed by health care providers. Here, both parties come into a “therapeutic alliance”.

What does non-adherence mean?

As the name suggests, medication non-adherence is the extent to which a person’s behavior for taking medications, following a diet, and/or executing lifestyle changes, deviates from the agreed recommendations from a healthcare provider.

Some related key terms

Discontinuation: It occurs when the patient stops taking the prescribed medication, for whatever reason(s), active or passive.

Intentional medication non-adherence: An active process in which the patient chooses to deviate from the treatment regimen. Non-adherence can be active in nature, arising out of ignorance, fear of potential side effects, cost, mistrust, misunderstanding, etc.

Unintentional medication non-adherence: A passive process in which the patient may be careless or forgetful about adhering to the treatment regimen.

Role, relevance and benefits of various stakeholders in medication adherence

Though patients play the main role, increasing healthcare costs have made all the stakeholders in the healthcare system actively seek ways to improve patient outcomes, which largely depends on proper adherence to medication.

Providers

Providers are essentially doctors who are responsible for diagnosing patients problems, prescribing him medicines, formulating diet plans, suggesting medication intervals and so on. Along with that, he should also be in a position to discuss associated risks of the medication and ignoring it. He should ideally also check in with his patients frequently to ascertain whether he is taking his medication properly or not.

Why medication adherence is important for providers? By ensuring medication adherence in his patients, providers can reduce hospital readmission rates, which in turn ensures no/less penalties by payers and government. Moreover, if a provider is successful in ensuring that his patient takes medication properly, it leads to superior clinical outcomes and positive quality metrics that impact reimbursement rates by payers. And, of course, it results in increased satisfaction and likelihood to recommend by patients.

However, on an average of 13-16 minutes spent with each patient, doctors find it difficult to squeeze in time to counsel patients on medication adherence. Even if there are a handful of providers doing that, scaling becomes an issue.

Pharma

Once the provider prescribes medication for an ailment, the next rung in the ladder is the pharmacist. He is the one responsible for filling prescriptions and explaining dosage and best practices to patients. However, once the prescriptions are filled, there is little way of knowing whether the patient is having his pills properly or not. Constant patient follow-up becomes an issue since the main performance indicator for a pharma is refill rate and not medication adherence.

Specialty pharmacies, on the other hand, take medication adherence of their customers seriously and often employ nurses or tele-agents to initiate targeted and personalized interventions that include Comprehensive Medication Reviews (CMR) as a part of Medication Therapy Management (MTM). However, given the limited number of such pharmacies and the high-cost drugs they sell, the scope to ensure medication adherence by specialty pharmacies is narrow.

If pharmas go the extra mile in ensuring medication adherence, it will mean increased refill rates that will keep the pharmacy and supply chain, both active. This leads to higher revenue for the manufacturers, which is a starting point for increased number of clinical trials and also greater chances of medication efficacy.

Patient

The doctor consultation is done, the prescription is also filled up. Now, the onus of taking the medication as directed by the physician lies with the patient. Patients are arguably the most important cog in the medication adherence wheel who are responsible for adhering to the provider’s and pharma’s recommendations.

By following medication adherence, not only do specific health conditions in patients improve but they also can avoid the pitfalls associated with unnecessary high doses that come with non-adherence. There is a great deal of savings in terms of cost due to reduced doctor consultations, emergency room (ER) usage and hospital admissions. Relapse rates also take a beating if patients adhere to medication properly. Lastly, it also leads to an increase in trust and a healthy doctor-patient relationship.

However, in the current scenario, most times patients do not adhere to their medication, either actively or passively. People either forget to take their medication on time or mess up with the doses or avoid it due to actual or perceived side-effects. There are also other reasons including high cost of medication, improper patient-doctor communication, general tardiness, etc that can spoil a patient’s adherence to his medication.

Payer

Payers are insurance companies that collect premiums from providers and pay for their claims, if deemed fit. In the medication adherence ecosystem, the role and relevance of payers is also of utmost importance along with other stakeholders. They are primarily responsible for bringing down the medical costs of the population that arises due to non-adherence.

Payers can ensure medication adherence by compensating providers for efficient patient monitoring and management, and patients through cash prizes, free medication, etc. Payers can also partner with providers and share information on refilling deviations by patients. This translates to high five-star ratings for Medicare Advantage Plans. If patients take medication properly and admission rates go down, it means payers have fewer claims to settle.

Other stakeholders that have a role to play in the medication adherence game and can benefit from the phenomenon are the government (reduction in healthcare spending due to improvement in general health), wholesalers (increase in retention of 5-20% margin on the total cost of the medicine, an an improvement in relationship with manufacturers and pharmas), and pharmacy benefit managers (more effectiveness in controlling costs).

In medication adherence, there needs to be a clear alignment, coordination and collaboration among all stakeholders to improve patient outcomes. One missed action from one of the stakeholders can, unfortunately, disturb the entire process.

What is the present medication adherence scenario?

Notwithstanding the multiple benefits of medication adherence, sadly, its present global scenario is largely skewed towards non-adherence. In the US, non-adherence is generally termed as ‘America’s other drug problem’ and ‘the silent killer’ due to the number of lives it takes annually, mostly due to low awareness levels. Around 2/3rd Americans with prescriptions do not follow adherence to medication.

So what are the consequences of non-adherence? As many as 125,000 people die prematurely in the US every year as they don’t refill or take their prescribed medication properly. What’s more, for people above 50 years, the death risk associated with medication non-adherence is 30x greater.

The costs associated with non-adherence are unacceptable too. In the US itself, $300 billion is the avoidable healthcare cost due to medication non-adherence. Global figures are perceptibly much higher.

View the full infographic here

What’s next?

“If medication adherence can make the lives of all stakeholders so much easier,” wonders Jim, “what can be the reason for so much non-adherence all over?”

To know more about it, Jim plans to go deeper and find out what ails the present medication adherence system. Stay tuned for it.

Find out before Jim

Do you want to have fast track access to the technology solution Jim eventually finds out to solve medication adherence woes? Learn more.

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