The Consequences of Improper Prescription Use
Did you know that medications aren’t taken correctly 50% of the time? Medication nonadherence has been called an out-of-control epidemic that costs more and affects more people than any other medical condition in the United States – and it’s 100% preventable.
Medication nonadherence can take different forms. Overall, one in five prescriptions will never get filled. And half of the prescriptions that are filled won’t be taken as prescribed. Patients who are prescribed medication for a chronic condition, for example, may take less of the medication than they’re supposed to — or stop taking the medication altogether. This includes patients with high blood pressure, with nearly half of these patients discontinuing their medication during long-term treatment.
The most expensive prescription is the one not filled.
- Eric Hart, MD, Chief Medical Officer
Unfortunately, taking medications improperly or discontinuing use can have serious consequences. The CDC estimates that 30% to 50% of chronic disease treatment failures happen because of nonadherence to prescriptions. This leads to 125,000 deaths per year in the United States.
Frustrated medical professionals often wonder why some patients aren’t taking their medications as prescribed. The reasons are numerous, and it is important to help people separate myth from fact. Some patients might not fully understand the directions that go with their prescription drugs. Others may be prone to forgetting a dose, especially if they have multiple different medications to take at certain times. The side effects experienced by some patients may cause them to give up taking a drug. Or, if someone thinks their medication isn’t working to the desired effect, they could lose hope in the medication’s effectiveness and give it up. Conversely, people with chronic conditions may stop taking medications once they feel better because they think they don’t need them anymore.
Cost is also a critical factor in nonadherence. If a patient can’t afford to fill their prescriptions regularly or takes a smaller dose to try to “stretch” the medication, they may end up being unable to manage their health effectively.
Medication Adherence Strategies for Patients and Providers
Healthcare professionals are looking for solutions to the serious problem of nonadherence. The cost of prescriptions is a top concern for patients, and finding ways to lower their out-of-pocket cost is vital. In our discussion below of the Healthstat clinic in Augusta, GA our provider offers her strategies for helping patients afford their medications, so they can take them correctly.
A healthcare delivery model that fosters an open dialogue between patients and their healthcare providers can improve medication adherence. Having that one-to-one connection can help keep patients on track. In a setting such as a workplace clinic sponsored by an employer, appointments are easy to obtain, the location is convenient, and cost is not a barrier to patients. This easy access allows a worksite clinician to closely monitor a patient’s response to their medication. They can clarify any misunderstandings about how and when to take medications as they arise. And they can respond appropriately to a patient’s experience of side effects as those may emerge. It’s the kind of open dialogue that helps ensure the right prescription is being taken in the right way for the right patient.
As discussed in this post on heart health, taking medications correctly is one of the building blocks of a healthy lifestyle. And in many cases, it can be essential to preventing a catastrophic event like heart attack or stroke.
For patients, certain tips such a taking your medications at the same time every day or getting a pillbox can help. There is a range of sophisticated dose reminder technology available. Ultimately, talking to a trusted healthcare provider is key. Asking for help, voicing concerns, and being clear about side effects is crucial for patients to stick to a prescribed regimen. Opening these lines of communication and developing a personal connection are made all the easier if a healthcare provider is easily accessible and the usual barriers to completing a visit are lowered.
For providers who want to promote medication adherence, there’s a strategy to manage the influence of social and economic factors as well as patient behavior – it’s called SIMPLE:
- S – Simplify the regimen
- I – Impart knowledge
- M – Modify patient beliefs and behavior
- P – Provide communication and trust
- L – Leave the bias
- E – Evaluate adherence
Onsite Clinics Can Offer the SIMPLE Solution!
Talking about health problems isn’t always easy for patients. Some struggle to articulate why they stop adhering to a medication. Others might not fully understand the health problems that can come with nonadherence. Healthcare professionals must therefore be approachable, empathetic listeners who ask the right questions to arrive at patient-centered solutions. A patient’s challenges can vary over time, so making sure communication is ongoing and education is up-to-date and easily digestible is important. A patient should feel empowered to share their opinions with their providers. In one study that demonstrated improved medication adherence, patients cited improved comfort in terms of asking clarifying questions, raising concerns about side effects, and collaborating in the development of their treatment plan.
Having easy access to a trusted provider in a workplace clinic can also help patients access the right team of clinicians to meet their needs in the community, across the care continuum. The onsite provider can help coordinate care with outside specialists, prepare the patient to ask the right questions, and help to find ways to lower the out-of-pocket costs for prescriptions. In short, onsite care helps the barriers to access fall away and patients can begin to practice better medication adherence.
The CDC concludes that medication adherence is critical to the improvement of chronic disease outcomes. It can also have a drastic impact in terms of reducing healthcare costs. They estimate that the direct health care costs associated with nonadherence have ballooned up to approximately $100–$300 billion of U.S. health care dollars spent on a yearly basis. One of the primary strategies to cut down on these costs and improve outcomes is “ensuring access to providers across the continuum of care and implementing team-based care.” Onsite clinics help do this — and as our post about choosing an onsite clinical vendor explains, they ultimately improve approaches to chronic condition management.
Behavioral and Cultural Influences on Medication Adherence
Medication adherence is a complex behavior. There are times when patients resist taking medication for fear of becoming dependent on it. A patient can associate the need to take medicine with being sick, which evokes a fearful reaction. They may identify themselves as a “healthy person” who doesn’t need medicine. Those with complex treatment regimens have further challenges remembering to take medication at the correct time, in the right dosage, and being sure to get timely refills.
Prescribed treatments may also be at odds with cultural beliefs. Culture affects patient perceptions of health and illness, beliefs about the causes of disease, approaches to prevention, how pain and illness are expressed and experienced, preferred types of treatments, and trust levels with the medical system and its providers. A patient who is not engaged in their treatment decisions or skeptical about their provider will be less likely to remain medication adherent. When there are underlying mental health issues such as depression or substance abuse, adherence can be further compromised.
Providers in traditional healthcare settings are often constrained by lack of time to communicate effectively with patients – and their families. There may be little time or ability to coordinate care among multiple providers. Further, patients may have limited access a provider for prescriptions or refills and face high costs and copayments. Healthstat’s workplace clinic for the employees of Augusta-Richmond County in Georgia provides insight to how these problems can be addressed to improve health outcomes and patient experience.
Onsite Care in Action: Healthstat’s Augusta-Richmond Clinic
With onsite clinical care, providers have more time to spend with patients. Providers can get to know patients’ family circumstances and uncover barriers to treatment adherence. They can figure out what’s really going on in their daily lives that’s preventing adherence. Then they can develop truly patient-centered solutions.
Our providers at Healthstat are trained in motivational interviewing and use behavioral coaching techniques. We encourage shared decision making between patient and provider, which helps to promote treatment adherence. And if a free medication isn’t available in our formulary, our providers use online tools such as CoverMyMeds to locate affordable options.
When employees get medication through a Healthstat clinic dispensary, they save money for themselves and their employer. But it’s not just the price tag of each dispensed medication that’s cost effective. Even greater dividends come from the connection built with Healthstat’s providers, as patients return to the clinic regularly – on a schedule timed to their prescription refills. The Augusta Health and Wellness Center in Augusta-Richmond County, GA is a great example of the compound value of Healthstat’s dispensary program.
Sarah Tripp has been the nurse practitioner at Augusta for over three years. Early on, at a Lunch and Learn for department heads, she told the group that she dispensed free medications. A newly- hired attendee said out loud, “Nothing is ever free.” Sarah explained that use of the clinic isn’t mandatory — it’s an added benefit. The medication she dispenses at the clinic is free and the patient’s privacy is protected. The new department head visited the clinic the next week and continues to use the Wellness Center to this day.
“Many patients say the clinic is the best thing the county has ever done and they didn’t even realize it at first,” Sarah explains. “By the end of this year, we’ll be expanding the clinic, staff and services we provide.” The onsite dispensary is an integral part of the clinic program. “It saves the patient time,” says Sarah. “It also saves the patient money. They have no co-pay to come to the clinic, and any medications provided here are also free. I try to prescribe from my formulary as much as possible. An onsite clinic dispensary does increase compliance because patients get a three-month supply all at once, and when they run out of medications, they know it’s time to be seen again. This keeps people healthier and allows a more open relationship with the provider about illnesses and what works and doesn’t work for them.”
Sarah and medical office assistant Melinda Rentz focus on building rapport and trust with patients. That’s evidenced, says account manager Brandon King, in how consistently people complete their follow-up visits for preventive care. Visit types are 70 percent disease management and 30 percent episodic care. “When it comes to managing health risks, you’re often talking about seeing the tip of an iceberg,” says King. “People get lab results, but they may not realize how serious a condition can become. Sarah and Melinda encourage people to understand their health concerns, so they will follow through on their return visits and stick with their treatment plans. It has saved people’s lives.”