When a person with type 1 diabetes skips or double-doses on insulin, they usually end up in the hospital, and the consequences are immediate and clear. On the other side of the spectrum, skipping a vitamin or painkiller once in a while does not have the same consequences. In between these two examples sit a number of medications for a variety of conditions such as arrhythmias, asthma, depression, hyperlipidemia, and hypertension. In these cases, skipping doses and other dosage mistakes may not have an immediate impact but can, over the long run, lead to serious negative consequences for the patient and the health care system. In fact, according to a report by the Mayo Clinic, 50% of medications are not taken as prescribed. This is a huge problem with a cost of over $300 billion a year to the U.S. health care system.
Danny Sands, MD
Today, the health care system often measures adherence by focusing on prescription fill efficiency and tracking whether patients possess their medications; clearly, you can’t take medications unless you have them. The proportion of days covered (PDC), for example, is a measure of how much medication a patient has on hand at a particular point in time.
But PDC can mask vastly different patient-adherence patterns that will have very different consequences. Missing doses seven days in a row results in the same PDC as missing a dose once a week over seven weeks. But not taking a medication for a week is usually going to be far riskier than a weekly missed dose.
As a health care system, are we providing the timely interventions to deal with these very different scenarios? The answer won’t come as a surprise to anyone working in the system: A resounding “no.”
More often than not, we rely on retrospective and incomplete claims data or patient recollection of their adherence when they are in a care setting. Neither provides the dose-level view of a patient’s actual behavior. And when a treatment is deemed ineffective (even if it’s due to nonadherence), the next course of action is usually a prescription for a higher dose—or switching to a more expensive option. This exposes the patient to additional risk and the system to greater costs. The cycle continues.
Advancements in technology have made it possible to get real-time insights into how patients are using their medications and to proactively engage with them while they are on medications. Health care now has the tools and capabilities to educate and enable patients to take medications as prescribed—and to inform the care teams in real time when they are not. However, to be effective these tools need to be relevant, timely, and reliable from the patient’s perspective.
It is critical, however, that technology support programs complement existing intervention programs. Technology can do a wonderful job of identifying patients based on risk levels and other patterns. But the most effective interactions between patients and care teams don’t stop there. They combine digital tools with support from health care professionals.
With the right tools, care teams can take corrective actions earlier, which is especially important when nonadherence doesn’t have immediate noticeable consequences. Early action can keep people healthier, prevent harm, and defuse ticking time bombs of downstream costs and quality failures.
The problem of nonadherence must be addressed. We must improve the sharing of a patient’s real-time medication compliance with care teams so that they are able to intervene in the right way at the right time. We must also educate patients. Medications can’t be effective if people don’t take them, and too many people don’t take them as prescribed.