The directions are usually pretty basic: Take 1 tablet once a day with water.
For eons, providers, payers and pharmacists have resorted to good old-fashioned trust and assumed that the patient was following those simple instructions.
After all, it’s hard to keep a constant eye on patients when they are at home. But trust alone doesn’t always translate to a patient taking the medication, or taking it correctly.
Medication nonadherence (or noncompliance) is a big problem. It cuts into quality and outcomes and raises costs. When patients don’t take their medications as prescribed, it leads to about 10% of hospitalizations and 125,000 preventable deaths annually in the U.S. According to one estimate, it also leads to as much as $300 billion per year in healthcare costs from complications and associated hospitalizations.
Patients with “low” or “intermediate” medication adherence were more than twice as likely as those with “high” adherence to be readmitted to the hospital, according to a 2017 study.
But readmission penalties don’t take into account medication adherence, which some argue is beyond hospitals’ control.
Even though they often know what they should be doing, patients still struggle to take medications as prescribed. They might not be able to afford their medications; almost 8% of U.S. adults tried to save money by not taking their medications as directed, according to the 2013 National Health Interview Survey.
They also might not understand how to take them correctly. Or they might not feel like the drugs are doing anything.
But the rise of new technologies gives the industry a potentially powerful way to improve medication adherence. Providers and pharmacists can now watch patients from afar and intervene when they aren’t following directions.
“What’s in it for providers and payers is, when people adhere to their drug prescriptions, they generally fare better from an outcome perspective,” said Christer Johnson, EY’s health analytics advisory services leader for the healthcare sector in the Americas. “There’s a dollar benefit to that, as well.”
In a 2015 study, researchers showed that for every 1% increase in prescription drug use, nondrug Medicaid costs decreased 0.167% for adults who aren’t blind or disabled.
Getting patients to take medications correctly isn’t entirely patriarchal—despite the harsh term “noncompliance”—or financial. It also has to do with ever-trendy patient engagement—getting patients themselves to take the lead in maintaining their own health.
“Greater engagement is going to drive much better adherence,” Johnson said.
Solutions include the physical—”smart” pill bottle caps—and the digital—apps. Some are passive, letting patients do the work of recording that they’ve taken a dose, and some are active, tracking patients as they take their pills and displaying the results in pharmacy management systems and in separate software.