People who suffer from chronic conditions need to take medication, in order to keep the associated manifestations under control. Such medication can provide relief from symptoms such as pain and inflammation, improving the overall quality of life. For a lot of people, taking medication has become part of the daily schedule. In fact, statistics show that an overwhelming percentage of Americans take at least one medication per day.
As the number of people who are taking medication increases, the concept of medication adherence gains even more importance. In the last decade, the number of people who take several prescription drugs has doubled. And the numbers will continue to grow. At the same time, it can be challenging to follow the instructions of the treating physician and take all of the medication as instructed.
What is medication compliance?
If you have been diagnosed with a condition, whether acute or chronic, you will most likely be prescribed a treatment. Medication remains one of the most used treatment solutions, helping one successfully manage the existent symptoms.
What is medication compliance? It refers to taking treatment as prescribed by a doctor, so as to obtain the full benefit of the medication. And, even though at a first glance it might seem like a simple thing to do, it can be a difficult objective to attain. Most people that are required to take over 2 medications only do so 67% of the time according to the World Health Organizations. The reasons for this are many: from not feeling the effects, money, forgetfulness, ability to get a refill and many more, below we will touch on all of these.
Medication adherence is a Big Global Problem
Healthcare systems are always on the lookout for solutions on how to increase medication compliance. The need for medication adherence is obvious, as more than half of those who are diagnosed with a chronic disease fail to follow the treatment regimen prescribed by their physician.
From another perspective, when one fails to adhere to the treatment plan, this has larger consequences. Non-adherence has significant health implications, decreasing the overall quality of life and increasing the risk of premature death, as a result of poorly-managed symptoms.
As part of the larger picture, non-adherence implies significant costs for the healthcare system. Only in the US, medication non-adherence was associated with avoidable healthcare costs in the value of $300 billion (annual value, 10% of the total healthcare cost).
The top ten annual causes of death in the US include heart disease, cancer, lung disease, accidents, stroke, Alzheimer’s disease, diabetes, influenza, kidney disease and suicide (mental illness). All of these death causes are influenced by personal health choices, with medication adherence being one of the most significant factors to take into consideration. (R)
Those who have been diagnosed with chronic conditions, such as type 2 diabetes or high blood pressure, and followed the medication plan as instructed, managed to save important sums of money in terms of healthcare costs (between $4000 and $8000). In those who suffer from chronic hypertension, treatment adherence could prevent premature deaths (89.000 annual deaths could be avoided through this solution).
When it comes to mental illnesses, things become even more complicated. It is difficult to establish a care plan and recommend psychiatric medication, the risk of complications being quite significant. Statistics demonstrate that approximately half of those who suffer from a mental illness fail to take their medication or take it infrequently. In consequence, this is associated with a higher risk of suicide, as well as losing one’s job or home. So, compliance in mental health patients is indeed a challenge, but one that can be overcome, as you will read below.
Chronic heart conditions are among the leading causes of death worldwide. And, even though the majority of people receive adequate treatment, as well as self-care recommendations, they rarely follow through. In fact, half of those who have been prescribed treatment for such chronic conditions, will not take it for more than a year. Compliance in chronic conditions is difficult and physicians put in a lot of effort, in order to improve adherence in their patients.
Chronic diseases affect more than half of the worldwide population and account for approximately 70% of deaths in America. Leading causes, as you have seen, include cancer and heart disease. The latter is the one that can be prevented most easily. It is expected that, by next year, the majority of the prescriptions will include generic drugs, with adherence representing the main issue to battle. (R)
Adherence in age categories: seniors and kids
Adherence is a major issue for the elderly population, as they present a higher risk of developing a diverse range of medical problems. When it comes to chronic conditions, and particularly those with an increased risk of premature death, medication adherence gains even more significance.
Imagine an elderly person who has limited mobility, suffers from diabetes, high blood pressure, chronic kidney disease and ulcers. That person would have to take at least a dozen of various drugs, with different doses and frequencies. If forgetfulness is also an issue, imagine how things will play out. Non-adherence is rather common in this age category, but it can be defeated through proper solutions and interventions.
In the situation that one fails to take his/her treatments as instructed, the medical issues can become worse. For the patient, this means more visits to the hospital and increased costs for healthcare. Moreover, if a medication is taken infrequently, it might fail to provide the desired result. This is what happens with diabetes medication, with one experiencing suboptimal blood glucose levels as a result of medication non-adherence.
Increasing adherence in elderly people is possible but one must first consider the factors contributing to the problem. Geriatric assessments are necessary to determine the reasons for non-adherence, including both mental and physical health. Often times, caregivers or family members can be there for the patient, improving the level of medication compliance. (R)
In children, things are not a lot different. Medication adherence is essential, as chronic conditions can affect their development and growth. In some cases, it might lead to life-threatening complications and eventually death. And, just as with seniors, there are numerous factors contributing to the lack of adherence.
Increasing medication adherence in kids is a major issue for healthcare systems, as adequate treatment compliance will ensure that the child will grow up to be a healthy and well-adjusted individual.
It has been demonstrated that babies require the highest amount of medication up to the age of a year. Older children, aged between 12 and 17 years old, will require medication as well, commonly for the treatment of chronic conditions. In children with life-threatening conditions, such as cancer or epilepsy, the rate of adherence varies between 50% and 60%, which is quite low. And it is also clear that low adherence is associated with a poor quality of life.
Adolescents have the lowest adherence rate, statistics show. In the situation that one fails to follow the treatment as instructed, the recovery time is slower and complications can occur. This is also associated with increased costs, for both the family and the healthcare system to which one belongs. As it happens in the elderly population, medication non-adherence equals more frequent visits to the hospital (emergency and hospitalization).
Children who suffer from chronic conditions such as asthma are among those who visit the emergency department most often. Despite the handout information with regard to how asthma can be kept under control, adherence is still a major issue. Factors influencing adherence in the pediatric population include the age, socio-economic status, family structure, culture, schedule, taste/formulation etc. (R)
The cost of non-compliance to the economy, health, and patients
As it was already mentioned below, in the US, 10% of the total healthcare costs each year regard medication non-compliance. These costs, which could have been avoided by improving adherence, amount to $300 billion.
According to a study regarding the economic impact of medication non-adherence, the cost per person in the US varied between $949 and $44190 (values for 2015, disease-specific).
The general costs for non-adherence varied between $500 and $5000. Non-adherence related costs were calculated in accordance to the healthcare system, visits to the emergency department/hospital and other medical expenses. (R)
How to increase medication adherence
Increasing medication adherence can be obtained by involving the patient more in the decision process. It is critical for patients to be involved in their own health. Pro-active screening is one of the most effective solutions to ensure the necessary compliance, as it can identify the need for specific medication in accordance to the diagnosed condition.
Regular screening can also identify patients who are at risk of medication non-adherence. Health education programs can be useful for both adults and children, helping patients gain knowledge with regard to their own treatment. Medication should be made more accessible by reducing overall prices. Family members ought to be educated as well – the purpose of the medication, the reasons for which the treatment was prescribed, potential side-effects and so on.
In the situation that we are talking about an elderly patient, who is struggling to remember and follow a treatment schedule. applications such as CareClinic might come in handy. The health app has a number of useful features, allowing one to set up reminders for each medication in particular. One can choose the dose and frequency for every drug, and there is even a snooze feature that serves as a frequent reminder that the medication was missed.
These are some solutions for increasing medication adherence in the elderly population:
- Health education programs
- Pro-active screenings for chronic conditions
- Involving the patient in the decision-making process (if possible)
- Involving caregivers and/or family members when establishing the treatment plan (+follow-up)
- Community-based intervention for patient engagement. (R)
Increasing adherence in children and adolescents can be ensured through the following measures:
- Simplification of medication plan (for example, recommending a single dose per day)
- Improving the taste/formulation of the medication
- Alternatives to pills (liquid form preferred)
- Frequent check-ups with the parents or other family members (adherence screening); counseling, health education and self-care plans
- Reminders (such as the ones offered by the CareClinic health app). (R)
- Tracking Symptoms such as Pain, Headaches, and other flareups to understand treatment effects
In conclusion, from the moment a patient is recommended treatment for a certain medical issue, he/she should remain in close contact with the treating physician. Frequent check-ups can ensure medication adherence but this is only a short-term solution.
Patients should be educated with regard to the importance of medication adherence, with self-awareness being obtained as a result. Health apps such as CareClinic can do wonders whereas compliance is concerned, as they are easy to use. Health education programs can reduce the costs associated with non-adherence, but one should never disregard the fact that each person is unique, and thus requires an individual approach.