Overcoming One of Health Care’s Greatest Hurdles: Patient Nonadherence

Maintaining adherence is key to improving the health of patients living with chronic or serious disease. For some, it’s a matter of life and death. Yet, as we know, the data of how many patients actually take their medications as prescribed paints a bleak picture.

According to the CDC, of the 3.8 billion prescriptions written each year in the U.S., one in five are never filled. Among the prescriptions that are filled, approximately half are taken incorrectly, while some long-term therapies for chronic disease are abandoned completely by the patient. Nonadherence is harmful to patients, accounting for 33 to 69% of all hospital admissions, and very expensive. The CDC estimates that health care costs related to poor adherence have grown to $100–$300 billion annually.

Chronic disease is anticipated to rise 57% by 2020. An influx of aging baby boomers who are expected to be less healthy than previous generations—55% more seniors will have diabetes and about 25% more will be obese—makes improving adherence mandatory in order to create better patient outcomes and stabilize health care costs. So how can health care help patients adhere to their prescribed therapies?

Barriers to Adherence

Research shows that the challenges of nonadherence are multidimensional and vary across disease states. For example, some patients may make a conscious decision not to pursue a medication recommendation due to potential side effects or the risk of dependency, whereas other patients may have difficulty managing complex regimens and multiple medications (kidney transplant patients take an average of 15 medications daily), or misunderstand how to take their prescription correctly. Still many patients simply forget.

Mental illness can be a big factor in nonadherence for patients. A study found that, “Among patients with major depressive disorder, 42% discontinue medications within the first 30 days of initial prescribing and 72% discontinue medications within the first 90 days of treatment. Additionally, 40% of patients with bipolar disorder are nonadherent at any given time.”

Poor adherence was estimated to be as high as 55% for patients with schizophrenia. The CDC determined that people who suffer from a chronic disease are more likely to also suffer from depression, confirming that behavioral health comorbidities shouldn’t be overlooked when trying to put the pieces together to solve the problem of nonadherence.

With the exception of mental illness, nonadherence is pervasive across diseases states and doesn’t appear to stand in correlation with any one specific condition. “Studies show that poor adherence impacts nearly every disease state — even progressive, chronic potentially debilitating and deadly conditions that have the highest stakes. These include diabetes, cancer, cardiovascular conditions, immune-system disorders, infections and post-organ-transplant treatment,” reported Pharmaceutical Commerce.

Social determinants also cannot be ignored when analyzing solutions to piece together the adherence puzzle. Many patients are unable to afford the prescription or copay, or can’t meet the high deductible of their health care to cover the prescription. A lack of stable housing and reliable transportation, as well as job flexibility are all some of the socioeconomic and demographic factors that can impede a patient’s ability to access prescriptions and take medications per their physician’s recommendation.

Looking at the many complex variables that potentially affect whether or not a patient will adhere to a prescribed therapy, it’s becoming increasingly clear that the episodic model for health care delivery is failing patients, and innovative, longitudinal support is needed to help patients adhere to their physician’s recommendations and achieve healthy outcomes. Technology is aiming to provide platforms for patients to get this much needed support.

Digital health’s response to adherence

When it comes to creating solutions for improved adherence, technology holds endless potential. As MobiHealthNews summed up, “…the economic implications of medication nonadherence will drive the market to look for tech enabled solutions to this complicated problem.” We agree.

A myriad of digital tools exist aiming to help patients and providers more successfully manage therapies including smart pillboxes, wearables, and ingestible sensors. A study that integrated a smart pillbox into a suite of remote monitoring tools alerting providers to the behavior patterns of patients with “poorly controlled diabetes” saw an improvement in blood glucose control and a medication adherence rate of 80 percent.

Another example is Common Sensing’s innovative device, Gocap, which helps people with diabetes improve insulin adherence. The device supports and monitors patients, not only tracking insulin dosing and time, but also providing them with ongoing coaching support. Because insulin injection data is recorded, providers know when patients deviate from their care plan and can intervene before therapy is sidetracked and major problems occur.

Technology can also help improve adherence rates through engagement programs, offering ongoing support to patients with chronic disease, such as population health management. Technology aids health care organizations in identifying the patients who are most at-risk of poor health outcomes and determining their barriers to care. This allows caregivers to coordinate solutions which ensure patients have the resources they need to stay on track with their therapies.

Consistent patient care and support is the only way to overcome the barriers to adherence, and technology is the most effective way to provide that level of dynamic patient support—a demand which will only grow as baby boomers age alongside increased health care spending. A digital solution can offer clarity to the complex issues behind nonadherence and allow for the delivery of truly patient-centric care, which is what’s needed to improve the outcomes of patients with complicated health issues.