A lack of social support is one of the chief barriers to medication adherence. If a patient has no friends or family to discuss their health and required medications with, they are more likely to skip them, says Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy at CIGNA® Pharmacy Management. When trying to resolve medication adherence issues, it’s important to understand which barrier applies to a particular individual, and then find a solution for it.
There are seven barrier domains that we have focused on as reasons for non-adherence. These reasons are:
- Knowledge — Lack of understanding of medication and its proper use, as well as lack of understanding regarding the disease and consequences. Also, failure to take medicine when feeling good.
- Motivation — Competing priorities win out over need to manage one’s disease. Carelessness or forgetfulness, as well as lack of readiness to improve adherence behaviors.
- Provider support — Doctor doesn’t take the time to discuss medication and its proper use or doesn’t discuss it in a way that can be understood.
- Lifestyle — Travel in job and/or lack of day-to-day continuity in order to establish routine for taking medication. Also, numerous responsibilities of competing importance.
- Social support — No family or friends with which to discuss health or medications.
- Health literacy — Does not understand terms used by providers, instructions on pill bottles or which medication is used for which condition.
- Medication and disease-specific issues — Discouraged by cost, complexity of regiment (too many pills), getting refills and fear of side effects.
When we look at individuals that are having adherence issues, these are the main causes that we find. We strive to identify the specific areas an individual is struggling with so we can support and help them to improve their adherence.
From a pharmacy standpoint, we’re trying to provide solutions in those specific areas for non-adherence. You’ll hear that cost is often cited as the main reason for medication non-adherence. If you are familiar with value-based benefits, you may be aware of some of the ways we’re trying to approach improving our benefits to reduce the cost barrier. It’s important to ensure that we’re looking exclusively at cost, as the only barrier to be resolved in a value-based benefit from the design that’s been put out there so far.
However, cost is not the most important reason people have cited for non-adherence. In fact, the number one reason cited — at 23 percent — is that people forget to use or refill their medication. Unwanted side effects account for about 20 percent, and cost follows at about 17 percent. Fourteen percent of the time patients question the need for the medication. Ten percent of the time patients can’t get to the pharmacy to get the prescription refilled, and 15 percent of the time the reason is “other” or “don’t know.” When we look at these areas, the focus is on taking the information and trying to understand which barrier applies to a particular individual. Then you can find a solution around that.
Guide to Improving Medication Adherence analyzes trends in improving medication adherence at more than 160 healthcare companies, and takes an in-depth look at pioneering efforts by Kaiser Permanente Colorado and CIGNA Pharmacy Management to improve medication compliance levels in their populations. Additionally, the past president of the Case Management Society of America shares a case manager’s take on what’s needed to move individuals toward medication compliance.