Citing a review in the prestigious Annals of Internal Medicine, the New York Times recently reported that people do not take their medication as prescribed. “This lack of adherence is estimated to cause 125,000 deaths, and at least 10 percent of hospitalizations, and to cost the American healthcare system between $100 billion and $289 billion a year.”
This news was not surprising to me. I know from professional experience that many prescriptions are never filled (20 to 30 percent according to the article), and that regardless of the condition for which the medication is prescribed, after three months only about 40 to 50 percent of those prescribed long-term medications are still taking them. I also know from controlled testing that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent.
There are many reasons why people don’t take their medication. Forgetfulness is not significant among them. So medication calendars, special pill bottle caps and refrigerator magnets can have only a marginal effect. Refill reminders from pharmacies and Rx brands are not effective, because the most significant reasons for non-adherence are psychological:
- Medications remind people that they are sick, or have a medical condition; many people would rather ignore or deny that. They see taking medications as a sign of weakness.
- Medications are viewed by some as chemicals that are bad for the body in contrast to “natural” remedies, like fish oil or vitamins.
- Medications for silent conditions, like high blood pressure or high cholesterol, don’t make people feel any different. So they see no benefit in taking them.
- Many times people do not understand why they are taking a particular medication or how long they’re supposed to take it. Doctors do not have the time to adequately explain it. The standard physician visit is scheduled for 15 minutes, and according to another Annals of Internal Medicine study cited by Forbes, “even when in the examination room with patients, doctors were spending only 52.9 percent of the time talking to or examining the patients and 37 percent doing paperwork. In other words, shrink that 15 minutes to under eight minutes.”
Direct-to-patient communications are an effective tool for overcoming these barriers to adherence. Educating patients about how their medication works in simple language can go a long way to helping them realize how and why to take it. The stakes are high, and the stakeholders who stand to benefit most from increased adherence (besides the patients themselves) are insurers, healthcare providers, pharmacies, and pharmaceutical manufacturers. Each of the stakeholders has their own roadblocks for mounting an effective program, which I’ll explore in a future post.