The current statistics on medication adherence are remarkably somber. At the moment, lower rates of adherence translate not only into poor health outcomes which result in 125,000 deaths per year, but also healthcare costs ranging from $100 to $300 billion annually. Over the past 30 years, the WHO and Institute of Medicine (IOM) have not been able to achieve their goal of rate improvement. By addressing challenges associated with health beliefs, learning styles, medication regimens, and inherent changes in patient status, pharma will develop the necessary support system to increase rates. Mobile phone interventions, patient literature, and pharmacy in-person consultations are critical tools of a multi-channel approach to maximize medication adherence.
Mobile Phone Interventions
The simplest form of mobile technology which increases medication adherence is text messaging or short message system (SMS) that includes program details, therapy reminders, and motivational information. This inexpensive vehicle provides a consistent flow of enhanced daily patient communication. Targeted and personalized information is quickly and conveniently sent via mobile phone to the right people at the right time. An OptumRx study involving experimental subjects who received several different kinds of medication alerts, refills, and dosage reminders culminated in an overall medication adherence rate of 85% on the experimental side and only 77% adherence on the control side.
On the other hand, adherence rates are higher when using the most complex form of mobile technology that includes artificial intelligence-adapted text messages with reinforcement learning (RL). RL automatically modifies SMS communication to provide data which is tailored to current needs and also adapted to future needs as patient status changes. The customized algorithms “learn” from their interactions with patients to determine the appropriate action that optimizes total reinforcement and motivates behavioral changes. In a University of Michigan project, researchers created a RL algorithm for innovative decision making based specifically on hypertension medication bottle openings recorded via electronic medication monitoring. A database tracked patient feedback from the medication event by monitoring system cap openings and then a RL engine learned from patient experience to determine individualized messages to send at specific times.
More than 95% of pharmacists believe patients who receive product-specific, easy-to-understand, and culturally relevant education brochures from the pharma industry, such as novelas with comic-book style images in the Hispanic culture, benefit from greater levels of medication adherence. However, the caveat is low literacy skills across all populations that often times result in a misunderstanding of prescription drug warning labels followed by an incorrect use of medications. The majority of prescription instruction sheets are written at a ninth grade level or above but almost 90 million Americans read below the fifth grade level.
However, patient literature is boundless in improving oral cancer drug adherence. Oral cancer medications are self-administered with patients taking charge of managing their own conditions. While perusing literature at their convenience during their own private time, patients not only educate themselves about their illness and the common side effects of oral chemotherapy but also develop the insight of when to seek emergency care. Literature motivates them to gain a better understanding of the condition and assume an active role in their treatment. The American Cancer Society states that some patients will not take their medications as prescribed because of depression or limited emotional support. However, further understanding the literature could motivate them to adhere to a specific regimen and view adherence as a means to well-being and a healthier outcome.
Pharmacy In-Person Consultations
Live patient counseling with pharmacists is the most effective channel for medication adherence. The tenet of “two minutes to trust building” is based on patients having a long-term healthier outcome when they are allowed to speak openly for a minimum of two minutes with free flowing conversation. At the pharmacy, patients discuss sickness more willingly and ask more questions. They are less intimidated by pharmacists than physicians partly because they do not see a huge divide in standing and do not feel a sense of inferiority.
A Walgreens study about a cholesterol level lowering regimen showed that patient face-to-face consultations with pharmacists result in the highest medication adherence. At the end of one year, well over 40% of the experimental group reached a target adherence rate of 80% or more, while only a little over 30% of the control group reached the same rate. Pharmacists need to be trained specifically to converse with patients about perception of therapy value, anxiety about side effects, absentmindedness, and the advantage of an established routine for medications. Prior to engaging in an effective consultation, pharmacists should complete a personalized non-adherence risk assessment which includes determining what patients know about their regimen presently, how patients can read labels correctly, their perception of efficacy and safety and the benefits of a demonstration.
In summary, medication adherence was at a standstill – until now. The old adage that talk is cheap certainly does not apply to our forward-looking pharmaceutical industry which recognizes the immense value of communication with adherence. Engaging in a multi-channel communication approach with mobile phone interventions, patient literature and pharmacy in-person consultations increases medication adherence rates, achieves healthier outcomes and lowers healthcare costs overall.
“Improving Prescription Medicine Adherence is Key to Better Health Care.” PhRMA. (2015)
“In-Person Consultation with Pharmacist May Improve Statin Adherence.” MedTera. (2014)
“Medication Adherence Time Tool.” American College of Preventive Medicine. (2016)
Mitchell, A. J. and Selmes, T. “Why Don’t Patients Take Their Medicine? Reasons and Solutions in Psychiatry.” Royal College of Psychiatrists. (2016)
“Patient Education Brochures, Other Approaches May Improve Oral Cancer Drug Adherence.” MedTera. (2014)
This is a great article and shines a light on the variety of opportunities and challenges that exist in enhancing the medication use process. In my opinion there is no single solution that overcomes all adherence barriers experienced by patients and this is truly a layering effect. Ms. DiPersio appropriately addresses the fundamental need to recognize the limitations of low health literacy before moving on to more sophisticated strategies. To this end pharmacies across the country, including large organizations such as Magellan Health and Humana, are providing patients and their families with video based information regarding what to expect from their medication and how to appropriately administer them when applicable; replacing the paper forms developed years ago. Here is an example from one pharmacy in FL – http://hub.medsoncue.com/qrc/usroon99FuUXdd8JDxvBq/en
Very informative and well wrtitten article!
Honestly I didn’t know about these tools. Thanks for letting me know – this is of big importance to me!