Patients average only C+ on drug compliance

Patients regularly prescribed medication averaged a C+ grade on drug adherence, according to a nationwide survey by the National Community Pharmacists Assn. One in seven flunked.

Researchers studied 1,020 Americans 40 and older who have been prescribed medications for chronic conditions and assigned point values based on answers about compliance behaviors. Nonadherence included missing or skipping a dose, forgetting whether a medication had been taken, taking the wrong dose, taking someone else’s medicine or ending a prescription early.

Neda Ratanawongsa, MD, MPH, an assistant professor in the Dept. of Medicine at the University of California, San Francisco, School of Medicine, said the health care system, rather than the patients, should get the grades.

“Adherence … assumes that the medicines that we as providers prescribe for people are exactly the right ones for them, and it doesn’t really put the accountability on providers for working with patients to find the best medication regimen for them,” Dr. Ratanawongsa said. When patients miss a dose because their lives are chaotic, they don’t like the side effects or they are trying an alternative treatment, they may be sending a message to the care team, she said.

Steps to better compliance

Stronger partnerships among doctors, patients, families and pharmacists will help bring adherence issues to light and then find the best regimen for the patient, she said.

Because patients were answering the questions over the phone and may have felt guilty or embarrassed when researchers asked the questions, noncompliance numbers are likely much higher, said B. Douglas Hoey, RPh, CEO of the NCPA, which commissioned the study by Langer Research Associates.

Hoey said the study found that cost was a significant barrier. Compliance scores averaged 9 percentage points higher among those who consider their medication very affordable than among those who say paying for drugs is difficult. That’s an area ripe for better communication between patients, doctors and pharmacists, he said.

“The most important predictor [of compliance] was the connection to the pharmacist or physician, but second was cost,” Hoey said. “If cost is preventing that patient from taking that medication, there’s almost always an acceptable alternative therapy that the physician might be OK with.”

But the physician may not know cost is a barrier, and the patient may not know there are options, he added.

Beyond the threat to a patient’s health, noncompliance comes with a hefty cost in terms of the higher likelihood of complications that result in additional emergency department visits, pharmacy prescriptions, hospitalizations, outpatient appointments and home health visits, research shows.

A June study by IMS Institute for Healthcare Informatics found the avoidable cost from medication nonadherence is $105 billion a year. The two diseases with the highest avoidable noncompliance costs are hypercholesterolemia ($44 billion) and diabetes ($24.6 billion), the study found.