Wednesday, September 1, 2010

Patient Non-Compliance, Revisited

The problem of patient adherence, an issue all too familiar to those in healthcare, was the subject of a recent Merck study. Researchers looked at 79 adherence studies, specifically on prescription non-fulfillment rates. (You can find the abstract on PubMed.)

PharmExec, which wrote about the report, (and sensibly talked to us about) said that Merck determined that 15% to 20% of patients do not get that first script filled. The drug maker classified non-adherence on four levels, from primary (not getting the script filled) down to secondary adherence (not taking medicines as prescribed.)

The report blamed non-adherence on three reasons. It said patients:
  • had concerns about the drugs;
  • didn’t think they needed the medicine;
  • couldn’t afford the drugs.
It pooh-poohed the myth that patients forget to take their medicines as a reason for non-compliance. PharmExec cited a couple of industry programs that seem to be working.

One was the Pfizer-Walgreens collaboration. Here, Pfizer is leaning on Walgreens’ pharmacists to make sure patients understand what they’re taking, and why. In the study, researchers found that the physician-patient disconnect -- reason for the prescription not explained well enough, not enough time during the appointment to do so -- was a major risk for patients not getting their scripts filled.

Patients just want to understand what's being said to them. They want to speak with professionals who can help them understand what's being prescribed to them without being judged for their lack of adherence. Our friend Dr. Grant Corbett explains this as the "competency world view." 

Maybe we should all take the view that patients are competent and need some positive coaching to improve their adherence.

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