Patient Medication Adherence May Result in Medical Misadventures – PATIENT

Terri Bernacchi, PharmD, MBA Health Advisory Professionals  

Finally!  Someone is recognizing that people don’t always comply with the dosage and instructions for their prescriptions (and are not always forthright with their doctors about the reality of their compliance).  When a physician notes that the medication doesn’t seem to be working, he or she increases the dosage, which may increase side effects and waste resources (at a minimum), if the patient actually does start to comply or is hospitalized and given the higher dose which is "new" to the patient. 

The evidence was collected by Medco Research Institute, the research arm of pharmacy benefit manager Medco Health Solutions.  The study concluded that nearly one-third of patients given increased dosages of antidepressants had not been regularly taking their original prescriptions. This is consistent with other studies of patient non-compliance or non-adherence----and people have a very difficult time being honest about taking or not taking their medications and the reasons they have for not taking them.  http://drugstorenews.com/story.aspx?id=154961&menuid=335

This is a quiet truth, the proverbial elephant in the room---that people lie----that many clinical failures or challenges are directly associated with behaviors that go unrecognized.   The clinical literature itself frequently draws conclusions based on an assumption of subject compliance.  Well-designed studies have measures in place to verify consistent behavior.

Now, the New England Healthcare Institute (NEHI) has called for a “national strategy” to examine the role care teams can have on improving patient adherence to prescription medicines.  The preface to their position paper which calls for Demonstration projects indicates that, “Poor medication adherence in all its manifestations costs the United States upwards of $290 billion per year in unnecessary health care spending, not to mention illnesses and deaths that could be otherwise prevented.”  A copy of the paper can be found at http://www.nehi.net/publications/48/medication_adherence_and_care_teams_a_call_for_demonstration_projects

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.