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Posts tagged with "compliance"

Are Patients Consumers?

When you are relaxing and watching your favorite evening television program or surfing the Internet and advertisements pop up for a cholesterol, anti-aging or arthritis medication, it leaves no doubt in your mind that you are being targeted as a consumer of health care.

Wikipedia defines a consumer as an individual who uses goods generated within the economy. As a health care consumer you need to be equipped with the information to choose your providers, medications and special services, based on the right price, features, brand recognition and appeal.

In the past if you had a medical problem, you saw your local general practitioner. He or she suggested a treatment and you generally followed those recommendations with little decision-making desire or power on your part. You were okay with that.

Today, there are so many variables, including cost vs coverage, efficacy of the treatment, and complex evidence-based diagnoses, that force the patient to shop for health care and make choices. The development of consumer directed health plans that most employers support because they save money, put you in the driver’s seat when choosing health insurance. These plans give you options for choosing your provider, hospital, pharmacy and other peripheral services such as therapists and clinics. They encourage you to choose health savings programs and flexible spending plans which include high deductibles and ways to put aside money to help pay for extraordinary health expenses should they arise. The cost analysis involved with consumer directed health plans forces you to stop and think about whether or not to seek treatment or put it off; whether to go to the community hospital or look for a specialist at a large academic teaching hospital where the costs are higher; whether to take the newest medication developed for a particular condition or a generic that will be cheaper and covered by the plan. Does this force you to become an educated consumer of health care? You bet.

This is not a bad thing. It is the way you are empowered with the information and financial responsibility to own your health care decisions and deal with your health in a holistic way rather than engaging in a knee jerk reaction to sickness and disease. It is a way of forcing you to plan and take actions that reinforce wellness prevention, compliance, treatment and early intervention programs. There is no question that consumerism in health care is a fact that you cannot avoid. Whether or not it will help to improve the quality and efficiency of your care and result in better outcomes is up to you.

User Friendly Medical Devices Could Alleviate Medication Non-Compliance

In my last blog post I noted that one-third to one half of all patients do not take medication as prescribed and up to a quarter never fill their prescriptions at all. This non-compliance with prescribed medication costs the US health system an estimated $290 billion annually. These costs are associated with expenditures for unnecessary hospitalizations, medical procedures, physician visits and treatments. Despite this staggering number this is just a starting point as the numbers quoted do not capture such costs as lost productivity and deterioration in quality of life. I put the blame for this non-adherence on the high, unaffordable cost of medication, the fact that people are forgetful and neglect to take their medications and the fact that often patients do not understand the reasons why following instructions about when and how to take medication is so important.

However, there is an additional  reason why people often do not take their prescribed medication properly and that is because the devices that deliver the medication are not designed in a way that makes them easy to use. In fact ,some devices are so poorly designed the patient cannot administer the medication at all.

Cambridge Consultants conducted a study that found a direct correlation between patient adherence to a drug regimen and the design of the drug delivery mechanism. The 240 diabetic patients who participated in this study indicated that they did extensive research on drug delivery devices that they would be using daily, and made their choices, not necessarily based upon their physician’s recommendation, but on their own perceptions about how the device delivered their medication. These respondents almost universally agreed that they would be willing to pay more for a device that is more user friendly and efficient.

A parallel study conducted by Cambridge Consultant of 100 health care professionals also concurred that the usability of a medical device impacts patient compliance with the medication therapy.,

The design of medical devices is regulated by the FDA , although the system is far from perfect. It has been a long road to institute regulations and standards that require manufacturers of medical devices to design in usability, design out usage errors, and provide documentation that is user friendly. By no means are we there yet.

The packaging of medication in containers that are safe and tamper secure, while at the same time enabling the average, possibly  elderly patient to easily access the medication is no easy task.

Over time this problem is going to become more complicated as the increasing numbers of individuals with chronic conditions use a variety of newly developed home monitoring devices and medication delivery systems, many of which will be based on a smart phone platform. It is important that patients have the right tools to manage their health conditions and medications. This will only happen when patients raise their  voice  and express their concerns so their health care providers  will  prescribe medications that patients completely understand and can use without a lot of challenges.

Did I Take My Pills Today?

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill their prescriptions at all. According to the New England Healthcare Institute, (a health policy research organization focused on enabling innovation in health care.) medication non-adherence costs  the US health system an estimated $290 billion every year.

This non-compliance regarding medication is not a new story. In April 2007, I wrote a blog where I pointed out that not taking medication properly was the cause of more than 50% of medication- related hospital admissions. A study of 39,000 patients and 335 primary care doctors by the Consumer Reports National Research Center, published in the February 2007 in Consumer Reports, noted that doctors’ number one complaint about patients is their failure to follow advice and adhere to a treatment regimen, which results in the high numbers of people landing in the hospital or back at a doctor’s office with the same complaint that they brought to their physician days or weeks earlier.

A new study, which focuses on four chronic conditions, found that patients who regularly adhered to their prescription regimen significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days spent in the hospital. Specifically, adherence reduced average annual health care spending by $7,823 for patients with congestive heart failure, $3,908 for hypertension, $3,756 for diabetes, and $1,258 in patients with high cholesterol according to the article.

There are three  reasons why people do not follow directions and take medication prescribed by their physicians:

1. Cost – many people, particularly those with chronic conditions who are on several medications come to a point where they have to make budget decisions and the pills are among the first things to go when money gets tight. The solution for these individuals lies not with changing their behavior but with the system. We have to find a way to bring down the cost of medications and co-payments to affordable levels so people can continue to take their medications . There have been several proposals that advocate paying people a financial incentive to comply with prescribed treatment such as lowering co-payments or creating incentives which reward people with cash if they comply.  To achieve a lasting solution, however, health insurers must begin to work with pharmaceutical companies and carve out plans for lowering the cost of some medications, as well as subsidizing \ individuals who cannot afford to pay.

A study funded by Aetna and the Commonwealth Fund, found that eliminating out-of-pocket costs for secondary prevention medications for patients after a myocardial infarction resulted in modest increases in adherence and improvements in some outcomes. This randomized trial showed adherence was roughly 4 to 6 percentage points higher among patients whose health insurers waived co-pays, than among those who continued to pay for prescriptions. Although these are not large percentages, it is good start toward making long term medication affordable to people with serious conditions.

2. Forgetfulness There are a large number of people who simply forget to take their medications either because they are too busy or they have memory lapses. The good news is that there are new systems with alarms available that remind patients when it’s time to take their pills – some even incorporate data collection to confirm that pills were taken on a regular basis. Devices like MedSignalsVitality Glo-Caps, and Dosecast, an app for the iPhone, IPad, iPod and iTouch that thelps you to remember when to take your medicines each day are examples.  Dosecast will even let you know if you have taken your last dose and if you are due for a prescription refill.

3. Education – patients frequently walk away from their visit with their doctor and have no understanding of why a prescribed medication is important and what will happen if they do not follow the treatment. Although there are isolated examples where physicians and pharmacists have worked together to develop effective programs to help people understand the purpose, potential side effects and why, using and completing a medication treatment is the only way the patient will recover, these coooperative programs are too few. As a result most patients are not given enough information and many opt not to refill their prescriptions. or they  self diagnose and determine that a drug is ineffective for them so they stop taking it. There are also the individuals who have difficulty swallowing their pills, or difficulty opening their containers, so they get frustrated and stop using their pills.

What can the patient do to take responsibility for medication adherence?

First and foremost, patients must speak up and question their providers about all of their medications and be sure that they completely understand why they are necessary, how to take them (in what dose and when), and the potential side effects. 

Patients who are still confused about a medications should talk with their pharmacist for further clarification.

Patients who have difficulty remembering to take their medications need to find one of the many medication reminders that are inexpensive  and available at the pharmacy,or free on many smartphones.

Patients who have difficulty opening the bottles should talk with their pharmacist who can supply bottles that are easy to open.
Patients who have difficulty swallowing should talk with their physicians who can prescribe substitute medications that may come in liquid form or who can suggest easier solutions for swallowing the medications.

Empowered patients do not leave these matters to chance or ignore the potential consequences.  They seek assistance and confirmation to make sure that they stay on track..