Last week, commuting to work on the DC Metro, I stumbled across a New York Times article talking about how some health care groups are paying patients to take their medications in an effort to improve adherence.
For years, people have been talking about medication adherence or the lack thereof and of course we hear the often repeated billion dollar number to characterize the costs associated with avoidable hospitalizations or lost productivity at work. While we might be becoming immune to the billion and trillion dollar figures increasingly found everywhere, there are still a few simple numbers that continue to stand out when it comes to treatment compliance:
- As many as half of all patients do not take their medications as prescribed.
- Upwards of 25% of patients never fill their prescriptions at all.
- Even for those patients who have health insurance and no treatment co-pays, non-adherence rates for almost 40%.
- Many doctors have too many patients and too little time - the average office visit lasts just fifteen minutes.
Many different organizations studying this issue, point to a number of issues that impact medication adherence - from coordination of care to factors at the individual level including psychological issues, health literacy, lifestyle choices and support systems. Along with the "pay for play" approach to incentivize patients to regularly take their medications, there are a number of additional innovative programs and products in development:
- Geisinger Health Systems has begun implementing programs to improve medication adherence by providing physicians groups with assistance by paying for additional nursing staff to help ensure that patients take their medications and stay out of the hospitals. They are also spreading the cost savings providing some medical groups with half of the savings achieved by reducing rehospitalizations.
- Community Care of North Carolina is piloting a program "Pharmacy Home Project" that will pay pharmacists a monthly fee to coordinate patient care.
- A number of companies (Medtronic, Boston Scientific, and) are developing "smart" defibrillators that monitor the heart and transmit information directly to doctor's office - something akin to a remote doctor's visit. A handheld unit developed by St. Jude Medical can be preprogrammed to instruct a patient to adjust their medication regimen, reduce their fluid intake or increase their physical activity based on the results of measuring their blood pressure.
While all these innovations point to the potential of harnessing the power of information and technology, it is becoming clearer that an essential component of ensuring successful treatment outcomes may be good old fashioned one-on-one communications. An interesting study recently conducted by the Center for Studying Health System Change, found that the use of electronic medical records (EMR) can both help and hinder physician communications with patients. While EMRs increased the efficiency for accessing patient information, there was also a tendency on the part of the physician to engage less with the patient and rely more on the electronic record.
Increasingly, we will have more and more technology tools, platform and initiatives to build stronger connections with patients. Yet these efforts become even more powerful if there are mechanisms in place to measure the patient experience that can in turn directly inform how we create effective communication programs that address disease management for the long term.
Tags: Disease Awareness, Medication Adherence, Patient, Physician
