Patient Safety & Clinical Risk Management

Welcome back! This is the sixth post in a series exploring the various problems posed by medication nonadherence. So far, we’ve discussed the scope of the problem and its impact, as well as a few ways that physicians and can tackle this growing challenge using both market based solutions and strategic remedies. Today, we turn our attention to the men and women on the front lines, the people literally put the medication in the patient’s hands: pharmacists.

While governments and markets can offer strategies and incentives for patients to take their medication, there are some quick and easy steps that physicians can take to address the problem right in the doctor’s office. In this article, the fifth in our continuing series on medication nonadherence, we’ll discuss some of those steps and how they work.

The overall strategy revolves around sharpening communication skills and consists of three components: First, monitoring adherence; second, promoting adherence; and third, providing effective interventions.

Welcome to the fourth article in our series exploring the scope and impact of medication nonadherence. This week, we will focus on government- and market-based strategies to improve medication management and adherence.

The stakeholders in this effort are numerous: patients; health care professionals; federal, state, and local governmental agencies; policy makers; third-party payers: private insurers; independent consumer groups and nonprofits; pharmaceutical companies and other commercial interests, such as those who make medication-adherence products.

The answer to the title question is, "It’s complicated" — because for most patients, there is not one unique and distinct reason for nonadherence, nor is there one simple solution for correcting it.

The complexity of this issue was detailed last year in a New York Times health blog post by Danielle Ofri, MD. Dr. Ofri, a New York City internist with a PhD in pharmacology, recounted what it would take for a 67-year-old patient who has diabetes, hypertension, and high cholesterol to be entirely adherent to all medical recommendations.

No matter how serious a medical condition is, there are patients who do not use their medications as prescribed. Nonadherence is found even among those patients with serious conditions. A recent study found that 11 percent of women with breast cancer did not take prescribed oral hormonal therapy. Another study determined that only about 20 percent of patients with rheumatoid arthritis used disease-modifying antirheumatic drugs correctly.