Medication non-adherence brings staggering costs. According to a study from the New England Healthcare Institute, one-third of all patients don't take their medication as prescribed. This non-adherence results in $290 billion of additional medical costs each year, of which $100 billion is medication-related hospitalizations.
People have many reasons for non-adherence—they either forget to take the medication or forget to refill the prescription, don't think they need it, or feel it's too expensive. To further compound the problem, often people think they are taking a drug properly when, in fact, they're not. NEHI research reveals that one-third to one-half of all patients don't take their medication properly.
According to A Report to the U.S. Surgeon General 2011, chronic diseases currently affect 45 percent of the U.S. population, account for 81 percent of all hospital admissions, 91 percent of all prescriptions filled, 76 percent of physician visits, and are the leading causes of death and disability in the U.S.
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Now consider what researchers at Harvard Medical School reported in a study published by the Journal of General Internal Medicine: More than 20 percent of new prescriptions for chronic conditions, such as high blood pressure, high cholesterol, and diabetes, are never filled. And even when a patient fills the prescription for a chronic condition, there's no guarantee they will continue to take the medication. Maintenance medications for chronic conditions show the lowest long-term compliance rates, which leaves those patients vulnerable to additional medical risks.
Solving the problem of non-adherence
One of the most promising solutions to the problem of non-adherence is disease therapy management, a type of program that approaches the patient and his/her drug treatment from a different point of view. Such programs create a partnership between a patient's physician and other clinicians including pharmacists and nurses in order to guide patients who have chronic conditions that require significant self-care efforts.
Through the use of coordinated health care interventions and communications provided by the pharmacist or nurse, patients learn the importance of adhering to their medication therapy in order to achieve treatment goals, receive maximum benefit from treatment, and avoid unnecessary medical complications.
The goals of DTM programs typically include educating patients about their medical condition, promoting self-management, increasing medication adherence, reducing health costs, and improving patient quality of life. These goals are achieved through:
• Telephone consultations with program participants to discuss medication details, possible drug side effects and food interactions, lifestyle considerations, and other important information
• Distribution of education materials and information, including drug updates and alerts
• Development of patient-specific care plans and ongoing care management services based on member needs
• Communication with the patient's other health care providers
• Referral services to external organizations for financial assistance or other disease management support
The patient-focused nature of the program ensures that the patient has experts to rely on during every step of treatment.
Improving outcomes, lowering costs
Studies have borne out the effectiveness of DTM programs for patients with chronic conditions. Comprehensive studies done by a leading pharmacy benefit manager and published in leading industry journals found that patients with chronic conditions achieved greater adherence and, consequently, better health through the use of DTM programs.
- Multiple sclerosis patients enrolled in a seven-month DTM program showed greater adherence to injectable MS medications and treatment persistence than patients who received injectable MS medications through a community pharmacy. By the end of the program, DTM participants had a 33.6 percent reduction in MS relapses. Previously published research shows that insured patients with MS typically incur two- to three-times more health-related expenses than insured patients who do not have MS. By reducing the number of MS relapses—and therefore, the health-related expenses associated with those relapses—a DTM program can deliver significant reductions in healthcare costs.
- Rheumatoid arthritis patients who enrolled in a seven-month, telephone-based DTM program, showed significantly higher adherence rates over patients who received their injectable RA medications through community pharmacies and did not participate in the DTM program. The average adherence rate for patients in the program was 83 percent, compared with an average of 60 percent for patients in the control group. These higher adherence rates, which were achieved through pharmacist and/or nurse phone calls, translated into better physical health for patients.
With more and more people delaying retirement, it becomes all the more imperative for employers to utilize an insurance plan that includes a clinician-based disease therapy management program. Many pharmacy benefit managers incorporate DTM programs into their product and services offerings because this personalized care for high-risk patients with chronic conditions provides very real benefits for both the patient and the employer.
Karen Stockl, Pharm.D., is director of clinical program development in the clinical services department of OptumRx, a UnitedHealth Group company. She can be reached at [email protected].
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