CMSA Today - Issue 1, 2015 - (Page 6)

President's Letter Medication and Treatment Adherence: Why Is It So Complicated? BY KATHLEEN FRASER, MSN, MHA, RN-BC, CCM, CRRN T he theme of this issue of CMSA Today is "Interventions: Medication & Treatment Adherence" and what a critical topic to cover. Dr. C. Everett Koop, former United States Surgeon General, recently stated, "Drugs don't work in patients who don't take them." It really should be just that simple, yet why is it such a challenge? In this issue, we are bringing you articles that will attempt to add some clarity and suggestions for how to improve adherence. So, what is adherence? It is a cluster of behaviors simultaneously affected by multiple factors. The extent to which a person's behavior such as taking medication, following a diet, or making healthy lifestyle changes corresponds with agreed-upon recommendations from a health care provider. Medication adherence is defined as the patient's conformance with the provider's recommendation with respect to timing, dosage, and frequency of medication taking during the prescribed length of time. The fact is that one in three patients fail to fill their prescriptions. Approximately 75 percent of Americans report they do not consistently take their medications as directed, and 33 percent never fill their first prescription. Sixty percent of patients cannot correctly name their medications, and up to 20 percent of patients take medications prescribed for others. Furthermore, approximately one-fourth of all nursing home admissions are related to improper medication self-administration. In addition, average adherence rates are between 50 to 65 percent in those with common chronic conditions such as hypertension and diabetes. So, what are some of the factors of poor medication adherence? Factors can include: * High out-of-pocket costs, especially for patients on multiple prescriptions for chronic conditions; 6 CMSA TODAY "Approximately 75 percent of Americans report they do not consistently take their medications as directed, and 33 percent never fill their first prescription." * Lack of care coordination, follow-up, and shared decision-making; * Complex or burdensome treatment regimens; * Multiple prescribed medications along with co-morbidities, such as severe and persistent mental illness; * Patients' fear of potential side effects from prescribed medications, whether real or perceived; * Personal factors such as lifestyle, culture, and belief system. Other factors that can also influence medication adherence are low health literacy, with reading level the single strongest predictor. Age actually does not relate independently to the problem, rather beliefs about their illness. Issue 1 * 2015 * DIGITAL One of the most direct ways to quantify the cost-effectiveness of medication adherence is to compare total health care costs and utilization for patient populations who are using prescription drugs appropriately versus those who are not. Researchers have found relationships between taking medications as prescribed and lower health care costs, as well as the converse relationship of not taking medications as prescribed and steeper health care costs. Each year, an estimated 700,000 Americans experience adverse reactions to prescribed drugs that require an emergency room visit. The estimated annual cost of patients not taking their medications as prescribed approaches $290 billion. Knowing this, what can we do as case managers? We must engage our patients in order for us to activate them with the knowledge, skills, confidence, and resources that patients possess to manage their disease state in an active and informed manner. The patient-centered approach we must use meets patients at their personal level of readiness to learn and accomplish their health-related goals. Patients with the highest levels of activation display interest and involvement, and actively decide the best course of involvement for themselves. These high activation levels are associated with decreased health care costs. There are some barriers that can interfere with successful medication adherence. For example, hospital settings are a difficult, stressful learning environment. Patients are in emotional and cognitive overload, are scared, and feel like they are bombarded with information. Also, many patients are in denial of their condition or overwhelmed by the number of lifestyle changes they must make. Continued on page 8

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