The Power of Patient Activation: Part One
Medication adherence is a primary determinant of treatment success. Yet, only 50 percent of patients with chronic conditions take their medications as prescribed.1 Non-adherence costs the healthcare system between $100-$289 billion annually and is associated with nearly 125,000 deaths and 10 percent of hospitalizations.2
The reasons for non-adherence vary widely and often change over the course of a patient’s treatment journey. Causes of non-adherence include social and economic factors; patients’ perceptions, motivations and levels of physical/cognitive impairment; issues related to the specific medication therapy; the medical condition being treated; and the patient’s healthcare system. The vast landscape of factors contributing to non-adherence has been aggregated by the World Health Organization as shown in in Figure 1 below.3 Identifying a patient’s specific adherence barriers and developing an individualized care plan with short- and long-term goals are essential to improving outcomes. The key to unlocking better outcomes is putting patients at the center of treatment and support and empowering them to be active within their own health journey.4
A Complex Problem
Medication non-adherence is a complex issue to solve because there is potentially a combination of many product- and patient-specific factors that can impact whether a person takes their medication as prescribed. Affordability, adverse effects and lack of education around medication regimen are widely known drivers of poor adherence. But what about the hidden factors—or combination of factors—that can only be discovered through personalized interactions?These factors might include a combination of the patient’s overall health literacy or understanding of the severity of their condition and ability to get to treatment sites on a regular basis. For example, just 53 percent of adults have intermediate health literacy (i.e., can read instructions on a prescription label and determine what time to take medication).5 Socioeconomic characteristics of the patient, such as gender, age, level of education and level of income also play a role. These contributors are often more critical to address than product-centric factors.
Patient-specific Reasons for Medication Non-adherence
Historic Approaches to Improving AdherenceMany adherence programs employ a one-size-fits-all approach that focuses on building product-centric engagement, with the belief that educating the patient on the drug’s efficacy, safety and dosing instructions is enough to keep them adherent and address the questions they may have.
Under a product-centric adherence program, each patient might receive calls at pre-specified intervals (i.e., days 3, 10, 30, 60 and 90), and each patient is given the same information on the product, condition and side effect management. If a patient has access questions and financial challenges, outreach can be made to the patient support team to obtain clarity on benefits and financial support services. Compliance programs that take this approach might be built on the belief that access and financial barriers are the only challenges patients face, and that by addressing these hurdles, the patient will remain adherent.
However, these product-centric programs may fail to unearth the true root causes of patient non-adherence and the social and behavioral determinants that often accompany them. Patients need more than well-intentioned, prescriptive advice. What is needed is an approach that addresses the complex interaction of motivations, health system barriers, perceptions of therapy benefits, socioeconomic and behavioral influences, and readiness to change. Taking a patient-centered approach matches a patient’s medication adherence needs with specifically tailored tools and strategies.
1. World Health Organization. Adherence to
long-term therapies: evidence for action. 2003. Accessed July 18, 2018.
Available online at: http://www.who.int/chp/knowledge/publications/adherence_report/en/.
2. Annals of Internal
Medicine. Interventions to Improve Adherence to Self-Administered Medications
for Chronic Diseases in the United States: A Systematic Review. 4 December
2012. Accessed July 23, 2018. Available online at: http://annals.org/aim/fullarticle/1357338/interventions-improve-adherence-self-administered-medications-chronic-diseases-united-states
3. NEJM Catalyst. Engaging
Patients to Optimize Medication Adherence. May 2017. Accessed July 2018.
Available online at https://catalyst.nejm.org/optimize-patients-medication-adherence/
4. Ibid 1.
5. U.S. Department of Education. The Health Literacy of America's Adults:
Results From the 2003 National Assessment of Adult Literacy. 2003. Accessed 9
July 2018. Available online at https://nces.ed.gov/pubs2006/2006483.pdf
7. Boskovic J, Leppee M, Culig J,
Eric M. Patient self-reported adherence for the most common chronic medication
therapy. Scand J Public Health. 2013;41(4):333–335. [PubMed]
8. Boston Consulting Group. The hidden epidemic: finding a cure for unfilled
prescriptions and missed doses. 2003. [Accessed September
10, 2013]. Available from: http://www.bcg.com/documents/file14265.pdf.
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Part two in our Power of Patient Activation series examines how leading support providers combine measurement with engagement to improve adherence. Be the first to know when it's available. Get these and other insights delivered right to your inbox.