CMSA Today - Issue 1, 2015 - (Page 15)

Medication Adherence "Remove From Foil Before Use" Understanding the Obstacles to Medication Adherence BY SCOTT PHILLIPS, PHARMD, MBA, MSCR T here is a reason pharmacists include "remove from foil before use" on suppository instructions. Common sense isn't so common, but the consequences are. Over 3.8 billion prescriptions are written every year, yet over 50 percent are taken incorrectly or not at all.4,6 The U.S. spends $100 to $289 billion annually in health care costs that could have been avoided by following directions.22 By the year 2030, nearly half of Americans24 will suffer from high blood pressure, high cholesterol, or high blood sugar. Yet according to patient polls, only 31 percent with high blood pressure can be categorized as "well controlled" while 35 percent with high blood sugar are "somewhat" controlled.20 Health plans are aware of how important medication adherence is to overall success. In fact, most health plans are graded on patient adherence and prescribing certain medications for specific conditions.16 Removing obstacles to patient adherence can have huge health and financial outcomes for patients, providers, and health plans. These obstacles are related to the way a patient interacts with the health care system, the patient's social or psychological situation, or the patient's specific therapy. The first interaction a patient has with the health care system is a provider visit. Typically a provider visit lasts for less than eight minutes.3, 23 So, while the entire appointment, from check-in to check-out, may last two hours, it is likely that the provider spent only a minute to communicate the reason and importance of the prescription. Patient trust is paramount, and the dwindling amount of time providers are spending is not helping. It's no surprise that among health care professionals, those who spend the most time with patients are considered most trustworthy: nurses, followed by pharmacists, then physicians.7 The second interaction a patient has with the health care system is at the pharmacy. Multiple studies show adherence decreases as the patient's costs increase. It is becoming more common for generic medications used to treat chronic conditions to have zero co-pays. While pharmacists are required to offer counseling in almost every state, less than 69 percent of patients accept the counseling.5 Despite the widespread accessibility of health information, health literacy is low. Reports indicate over a third of adults lack the skills to read and follow medication label directions.2 Cultural or ethnicity influences create additional obstacles. In some Hispanic circles, the most trusted individual for medical questions is not a physician, but instead an older lady, "la señora," and in most Asian cultures there is a reliance on traditional medications, with Western medicine sometimes considered taboo.1,17 Many individuals in critical need of health care services live in poor socioeconomic environments and suffer from conditions that require complex medication regimens. Chronic conditions often require three or more medications. Many patients with heart failure are prescribed medications for their heart, kidneys, and fluids. These medications could be dosed three times a day and are not available in a single combination pill. A regimen consisting of only these medications is complex enough, but most individuals suffering from chronic heart failure take over 10 medications daily.9 Failure to follow medication instructions is one of the major reasons for heart failure readmissions.12 Other conditions may require medications that have unpleasant side effects or complicated administration. Injectable medications in many communities have stigmas and are often associated with the consequences of the conditions they treat.13 Until recently some of the most common medications to treat HIV and Hepatitis C came with side effects that varied from flu-like symptoms, skin rash or noticeable build up or loss of body fat.11,21 Non-traditional dosage forms such as inhalers, nebulizers, patches, and gels not only require higher levels of coordination, but may have confusing instructions. Poor medication adherence is a widespread, costly problem. Awareness of the obstacles is the first step in addressing the problem. All health care professionals impact medication adherence - from providers spending a few extra minutes to communicate clearly and effectively at the appropriate literacy level, to health plans designing benefits with zero or reduced copay, to pharmacists coordinating refills and counseling on medications, to nurses performing post-discharge, telephonic follow-up. ■ References included on page 17 Issue 1 * 2015 * DIGITAL CMSA TODAY 15

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2015

Medication and Treatment Adherence: Why Is It So Complicated?
Association News
CMSA Corporate Partners
Medication Management in the Community
Remove From Foil Before Use
Index of Advertisers

CMSA Today - Issue 1, 2015