Ernest Boyd is the executive director of the Ohio Pharmacists Association, which is a member of the Ohio chapter of the Partnership to Fight Chronic Disease.
Affordable, accessible and quality – these are the terms most often used to describe the health care system that we all hope to achieve. However there is another term that all too often goes unmentioned yet it’s as critical as the others – adherence.
The idea of “following doctor’s orders” may sound simple enough but too often the doctor’s advice to manage disease through diet and exercise, smoking cessation, taking medications properly, or following other treatment regimens is not followed. The Centers for Disease Control National Health and Nutrition Examination Survey of 2008 found that many cases of chronic disease are undiagnosed, untreated or uncontrolled. Improving adherence among those with chronic illness can reduce overall health care spending. For example, better adherence to diabetes medications would significantly lower total health spending: for every $1 spent on diabetes medications, $7.10 less is spent on other health care services.
The Diabetes Ten City Challenge is a great example of how adherence can make a difference. This successful program worked through employers to incentivize employees and dependents to better manage their diabetes care. Using a team approach of pharmacist coaches, physicians, and community health resources, the results were outstanding. Total health care costs for the participating employers were significantly reduced as was absenteeism and workers’ compensation claims, among other successes.
Medication adherence is the extent to which the patient follows the doctor’s instructions about the timing, dosage and frequency of prescribed medicines. However, many patients acknowledge not taking their medicines as directed. According to the New England Journal of Medicine, among patients who actually fill their prescriptions, 50 to 60 percent don’t take their medicines as prescribed, meaning they skip doses, take less than the recommended amount, or stop taking the medicine earlier than they are instructed to do so.
Successful treatment of disease depends on the patient both receiving appropriate medical advice and following it. Â Pharmacists play an important role in helping patients adhere to prescription labels and to stick with an overall treatment regimen. Along with health care providers and patients, we should all strive for better adherence rates as one way to help improve our health care system.
There are many reasons for the ability, or inability, to follow doctor’s orders. Certainly, some patients are unable to afford treatment costs or co-payments, or lack even adequate access to care, especially to preventive care. One 2005 study from Harris also found that some patients don’t follow instructions or don’t understand them. Other patients, especially among older adults, don’t experience significant symptoms and therefore think that they do not need to continue treatment. This situation is especially prevalent with patients under treatment for high blood pressure.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Right now, Congress is preparing for sweeping changes to our system of health care. Our federal leaders are addressing the cost of health care and how to increase access for all Americans. Into this mix of debate, our lawmakers must consider the quality of health care and how to encourage healthy lifestyles and adherence to treatment regimens.
