Poor Medication Adherence Rates Prompt Formation of Broad-Based Coalition

AAFP Joins Prescriptions for a Healthy America

May 07, 2013 12:30 pm James Arvantes Washington –

AAFP Board member Rebecca Jaffe, M.D., M.P.H., (center) makes a point about the importance of primary care and the patient-centered medical home during a press conference announcing the launch of a new nationwide campaign to improve medication adherence rates.

The AAFP has joined a broad-based coalition that wants to improve patient care and save billions in health care costs by implementing strategies to improve the nation's medication adherence rates. Known as Prescriptions for a Healthy America(adhereforhealth.org), the coalition is made up of 30 organizations that represent a broad range of stakeholders, including physicians, pharmacists, health care industry leaders and consumers, among others. Coalition members held a press conference on Capitol Hill on May 2 to announce the launch of the initiative and to identify ways of improving medication adherence rates in the United States.

"We are a diverse group of stakeholders, but we have come together because we all recognize the important role medication adherence plays in improving the quality of life for our patients," said AAFP Board member Rebecca Jaffe, M.D., M.P.H., of Wilmington, Del., one of six panelists to address the press conference. "As a family physician, I see the negative impact nonadherence has on patients each day. I also see the positive impact that adherence to treatment protocols has and the improved quality of life many individuals experience as a result."

story highlights

  • The AAFP has joined Prescriptions for a Healthy America, a broad-based coalition that wants to improve the nation's medication adherence rates.
  • Six out of 10 patients do not take their medications as prescribed by their physicians, and patients with multiple chronic conditions have the lowest medication adherence rates, according to AAFP Board member Rebecca Jaffe, M.D., M.P.H., who spoke at the press conference.
  • Jaffe stressed the importance of primary care and the patient-centered medical home in improving medication adherence rates.

Jaffe said six out of 10 patients do not take their medications as prescribed by their physicians, and patients with multiple chronic conditions have the lowest medication adherence rates. She also described poor medication adherence as a "leading driver of hospital admissions and readmissions" and the cause of 100,000 deaths a year.

"Through efforts like this campaign, we can raise awareness about the importance of ensuring patients have access to affordable pharmaceutical products, and (that) they understand when, why and how to take their medications," said Jaffe. "We can identify and promote best practices that have been proven effective and provide the framework for developing and implementing new, promising programs."

Jaffe stressed the importance of primary care and care coordination in improving medication adherence and adherence to all treatment protocols, saying that "research clearly demonstrates that patients who have access to continuous and comprehensive primary care have better health outcomes." And, the most effective model for delivering advanced and coordinated primary care is through the patient-centered medical home, Jaffe said. "The medical home works to ensure that patients have access to physicians and other health care services, that patients are keeping their appointments and that the patient is complying with treatments prescribed by their physician."

Economic Consequences

Jaffe and other speakers at the press conference also addressed the economic impact of nonadherence. John Castellani, president and CEO of the Pharmaceutical Research and Manufacturers of America, said hospitalizations related to nonadherence cost the U.S. health care system $100 billion a year.

"Improving adherence for diabetes alone could result in more than 1 million avoided emergency room visits and hospitalizations every year, saving over $8 billion a year," said Castellani.

Sally Greenberg, executive director of the National Consumers League, the oldest consumer organization in the United States, talked about barriers to adherence, saying that "there are many reasons why patients are not adherent."

Some patients may be reluctant to remain adherent because of medication side effects, such as sleeplessness or weight gain. Others may be unconvinced about the need to take medications because they do not have symptoms associated with their chronic illness, Greenberg said.

Forgetfulness is another issue for some patients, making it difficult for them to remember to take their medications. Out-of-pocket costs may be a challenge for some patients, as well, creating barriers that discourage patients from filling prescriptions, according to Greenberg.

However, patients are more likely to remain adherent if they understand the ramifications of adherence on their long-term health and the consequences of poor adherence, said Greenberg. This makes "conversations between patients and health care providers critical to health care," she noted, because these conversations offer "a gateway to better health care outcomes across the board."

Survey Results

The coalition also released the results of a national representative survey that showed 64 percent of Americans who take medications reported not always taking their medications as prescribed. Only 33 percent said they never miss taking prescription medications as prescribed.

The survey, which was conducted jointly by Greenberg Quinlan Rosner Research and Public Opinion Strategies, also found that patients who take multiple medications are the least likely to be adherent. Seventy percent of individuals who take three or more medications do not take them properly, and 56 percent of patients who take one or two medications do not take them as prescribed.

Survey respondents also identified possible ways of improving adherence rates, including by increasing one-on-one communication between patients and their health care professional and providing clear information about medications. Respondents cited other ways to improve adherence, as well, such as care coordination and access to tools that help patients remember to take their medications (e.g., pill boxes, e-mails and phone reminders).

The patient is the most important part of the health care team, said Jaffe, making it incumbent on other team members to involve patients in decisions and activities. "We need to talk with them, not at them," said Jaffe. "We need to ensure they understand and accept the plan developed.

"These are the reasons why the AAFP is so enthusiastic about this campaign -- because we know we can make a difference."

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