Missing Doses

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Healthcare experts search for ways to improve patients’ adherence to medication, a problem estimated to cost nearly $290 billion a year.

It’s one of the costliest and deadliest problems in healthcare. When people don’t take their medication as prescribed, it causes nearly 125,000 deaths and runs a tab of $290 billion every year, according to a report by the New England Healthcare Institute. Called nonadherence, this stubborn quandary has a multitude of causes – vexing doctors, pharmacists, insurers, the government and researchers.

“It’s a huge problem, and it’s a major healthcare driver in our system,” said Laura Cranston, RPh, executive director of the nonprofit Pharmacy Quality Alliance in Springfield, Va. “Nonadherent patients wind up in the ER, and they get readmitted to the hospital because they are failing to take their medications appropriately.”

Nonadherence is a wide-scale problem, with a third to a half of all patients not following their doctors’ orders for medication, according to the New England Healthcare Institute report, “Thinking Outside the Pillbox.” The institute’s research quantified the $290 billion annual price tag, which accounts for 13 percent of yearly healthcare spending in the United States.

There are many reasons patients don’t comply with their prescriptions. For those with chronic conditions and many elderly people — more than half of whom take more than six medications daily—it’s difficult to sort out what drugs to take when, multiple times a day, explains Paul Austin, healthcare program manager at Xerox.

Many grapple with the cost of medications, and others don’t follow doctors’ orders for behavioral reasons. For example, patients with high cholesterol may feel fine when they don’t take their pills, yet suffer side effects like drowsiness and muscle aches when they are on the medication, Cranston says.

Such diverse root causes means there isn’t one easy solution. But experts in many corners of healthcare are designing new ways to encourage adherence. Some involve deepening communication between doctor, pharmacist and patient, while others deploy technology to help.

Xerox developed a personal medication management system that pairs technology with innovative packaging to help patients follow their prescriptions. A blister pack includes a week’s worth of medicine in a grid representing morning, lunchtime, dinnertime and bedtime. It includes self-contained spaces for multiple pills, with pictures to show patients exactly which drugs to take each time.

With a smartphone app, text, email or phone call, the system reminds patients to take their medicines throughout the day. They respond that they either took all of their medication, some of the medication, or if they want to speak with someone. “We’ll connect them with the pharmacist by phone, who can help them with side effects or suggest taking it in different ways — with milk instead of water — whatever is appropriate to get the maximum effect,” Austin said.

The Xerox system differs from other medication reminder apps because the pharmacist sets up all of the technology and medication. “People are having to go through their pill bottles and create their own regimens. It’s confusing and complex and one of the reasons why people don’t adhere,” said Anthony Marino, vice president of Xerox. “With our system it’s very easy to observe compliance, because the blister pack is perforated and the medication is gone when they take it.”

Also on the horizon from Xerox: personalized videos from physicians that send their patients home from the hospital with specific instructions on follow-up care. The videos could include how to take their medicine, how to care for an incision and how to detect an infection, Austin adds. This reinforces instructions for patients who fail to comply because they get overwhelmed by numerous directives.

Cranston says changing the way doctors prescribe medication also can improve adherence. Using e-prescription systems, physicians electronically send prescriptions to a pharmacy instead of relying on the patient to drop it off. If patients don’t pick up their medication, the pharmacy calls three times to remind them. After a week the claim is reversed, informing the physician that the patient never got the medication. That could open up the conversation between doctors and patients about their medication concerns.

E-prescribing can have a big impact. Surescripts, a provider of e-prescription services, found in a 2012 study of 40 million prescriptions that when physicians electronically prescribe medication, there is a 10 percent jump in first-fill medication adherence — when patients pick up a new prescription. Surescripts projected that such an increase could save $140 billion to $240 billion in healthcare costs and improved outcomes during the next 10 years.

“The technology is there” to encourage adherence, said Cranston. “Programs are getting more sophisticated and getting down to the patient level.”

And that’s when it really can make a difference.

One Response to “Missing Doses”

Indy Kavelaars

Dear Suzy Frisch,

I like to receive more information about the system from Xerox that is trying to improve medication adherence! Where can I find more information?

Thank you!