Non-adherence goes beyond the simple idea of not taking medicine that is prescribed. Non-adherence can happen because of timing, frequency, or the dosage of a medication.
The Surgeon General divides these versions of non-adherence into three categories:
- Primary non-adherence (A patient does not pick up or take the prescription)
- Discontinuation (A patient stops treatment before the prescribed end-date)
- Compromised Execution (A medication’s use instructions are not followed. e.g, skipping doses or splitting pills)
Medication has become significantly more effective over the last decade but studies have shown that treatments have lower success rates than what is initially projected. A major cause of this outcome has to do with medication adherence.
Non-Adherence has multiple causes including the complexity of the prescribed plan, a lack of communication between patient and provider, and socioeconomic barriers for patients.
Medication adherence has proven to improve health and reduce costs, prompting industry professionals to take a closer look at solutions. In the United States, it is estimated that 20-30% of prescriptions are never filled. Even after they are filled, there is a 50% chance that the continued use of that medication will not be followed as prescribed, especially after the first six months.
Consequences of Non-Adherence
Lack of adherence is responsible for approximately 125,000 deaths and 10% of hospitalizations annually. These statistics show that medication non-adherence can cause a decrease in a patient’s quality of life. The reality is that non-adherence goes deeper than health risks and can hurt more than just the patient. Nonadherence can lead to increased use of medical resources like lab tests, physician visits, ER visits, hospital admissions, and additional preventable treatments.
Many patients who do not adhere to medical plans will actually have higher medical costs. It is estimated that if we looked at diabetes alone medication could save patients $4.7 billion dollars. If we look at the industry as a whole non-adherence can cost the healthcare system up to $100 billion dollars per year.
Dimensions of Non-Adherence
Every patient is different when it comes to disease, illness, treatment, and reasons for not adhering. As a provider, it is important to be aware of which factors your patient may be at risk for falling victim to and intervening as early as possible.
- Healthcare System
- The complexity of the material given to patients within their treatment plan can cause the success or the downfall of a patient treatment plan.
- It is important to keep the patient’s treatment plans written in plain English and not medical jargon.
- Access to care is an extremely important part of adherence. If a patient is blocked from receiving the necessary treatment their conditions may get worse.
- Access can be prevented based on the location of the patient versus the location where needed services can be provided and providers can be trusted by the patient.
- If a patient does not have health insurance or the necessary treatment is too costly, there is a greater chance that the medication prescribed will not be adhered to.
- There may also be delays in receiving the appropriate care because of the factors listed above.
- Continuity/Quality of care can be impacted by:
- The stress of healthcare visits
- The inability for patients to trust their provider
- Patient’s forgetfulness or carelessness
- Lack of immediate benefit of therapy
- Continuity/Quality of care can be impacted by:
- Therapy Related/Condition Related
- If a patient does not understand the medication they are prescribed
- If a patient’s regimen is constantly changing it may be difficult for the patient to stay on track
- Medications with social stigma are more likely to not be adhered to.
- If the treatment required a specific technique that has to be mastered
- Economic and Social
- Health insurance costs
- Medication costs
- Limited ability to speak English
- Inability or difficulty to access a pharmacy
- Lack of social and/or family support
- Unstable living conditions
How can Healthcare Technology help?
Healthcare technology can be expensive to implement if the proper research is not done prior to starting a new program. The reality is that not implementing it can be even more costly, labor-intensive and the results may not be as dependable.
Healthcare technology can create a less intimidating environment for a patient. If doctor’s visits are causing the stress that leads to non-adherence in patients a telemedicine app can help. Even something as simple as implementing secure SMS and text as well as email can open up an option for comfortable communication for patients.
It can also create an environment that is accessible to those who do not have access to the specialists they may believe they need. Push notifications can reduce a patient’s forgetfulness. It can provide patients with additional resources to better understand their condition and give them the ability to track and stick to their regimens.
What’s the delay?
For many hospitals and providers, the problem falls in the budget and the reality of having to plant many hooks into various systems to create a robust solution. Many developers are spending their time maintaining and managing existing systems. This leaves many providers feeling as though they do not have the resources to make the leap into the next step to engage with their patients.