Wednesday, May 26, 2010

NY Times Articles-Medication Adherence

“Failure of patients to comply with therapeutic regimens is a continuing source of frustration to physicians and clinicians. Only recently, however, has it become the subject of special investigations.” See the NY Times & NY Times Blog

No, you haven’t missed a thing – W.L. Ball, MD, wrote those lines in 1974 in the Canadian Medical Association Journal.

The problem of patient noncompliance lingers, festers, metastasizes. Back in Dr. Ball’s time, only a handful of people didn’t fill a new script. A new Harvard study now shows that percentage has grown: More than 20 percent of patients do not even go to the pharmacy and get their prescriptions filled.

Reams have been written on why people won’t take their meds as prescribed: They don’t understand what they’ve been told to do; they don’t have the money to fill the script; it’s too inconvenient to go to the pharmacy; and most importantly, they don’t have the education to appreciate the severity of their disease. The latter, incidentally, was not considered a factor in Dr. Ball’s time, but health literacy is a big part of the growing healthcare problem in this country.

The stakeholders here – industry, physicians, retail pharmacists, pharmacy benefit managers, managed care organizations, employers and even the government – claim they want to see patients take their drugs as prescribed. But who’s problem is this really? No one seems to be willing to take the lead and help drive this change. That would mean claiming ownership, at least partial ownership, of the problem, and no one wants to do that. They want to know who is going to pay for it?

That short-term view might look a tad foolish, 10 years down the road, when all those people who haven’t taken their meds for all their chronic diseases start consuming a lot more of the healthcare dollars. What will happen then?

“Medication non-adherence undermines even the best cost-saving and clinical intentions of evidence-based care,” according to the NY times article. We think people should do something about it. Each stakeholder in the medication therapy management process has a responsibility. Only by working collectively can we really solve this problem. We have some ideas and have done some work with a lot of bright minds on this issue. However, there is room for more. Tell us your thoughts.

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