Medication Non-Adherence Challenges and the Doable Solution

By Dr. Batami Sadan

The world-known issue

Many patients frequently do not adhere to significantly essential medication. Poor medication adherence result in poor clinical outcomes and may lead to morbidity, mortality, increased health care costs and harmful consequences for workforce productivity and overall public health. Half of the 3.2 billion annual prescriptions dispensed in the United States are eventually not taken. Estimates are that approximately 125,000 deaths per year in the United States are due to medication non-adherence.
Suitable medication adherence remains a challenge.[1]

Patient’s self-management, especially for long term chronic conditions, may help improve health outcomes as well as reduce the cost of care. It requires efficacious tools which can enable patients to manage their own care with less reliance on healthcare professionals. Such tools may include smart medication management dispensers that monitor adherence, as well as free access to internet healthcare information, remote monitoring and telephone support. Combining these will allow patients’ connectivity with providers, pharmacies and healthcare system’s data.

Common interventions and their outcomes

Medication adherence interventions have been more successful for short-term treatment than long term; only 36 of 83 interventions reported in 70 randomized clinical trials (RCTs) were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome.[1]

However, almost all of the interventions that were effective for long-term care were complex, including combinations of convenient, reachable care information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Thus, even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.

Recently conducted trial, combining interventions

A randomised controlled trial [2] using Telehealth for patients at high risk of cardiovascular disease was designed to assess whether a non-clinical staff can effectively manage people at high risk of cardiovascular disease using digital health technologies.

Results
Only 50% (148/295) of participants in the intervention group responded to the treatment, in comparison with 43% (124/291) in the control group.

Conclusions
This evidence based telehealth approach was associated with small clinical benefits for a minority of people with high cardiovascular risk, and there was no overall improvement in the average risk.

Recently conducted trial, combining a complete medication management solution and interventions

A study [3] was conducted by St. Helena Health with Chronic Heart Failure (CHF) patients and was monitored by Vaica’s SimpleMed+ (a smart medication management dispenser), that logs taken medication doses and outputs reminders. The reminders are programmable and can escalate from visual and audible alerts to text messages and emails.

The results were quite positive: Adherence to medication was sustained above 94.5%, 98% taken if including late doses during the monitored period. This resulted in 68% reduction in emergency room visits, a 72% reduction in hospitalization and 78% reduction in the length of stay. It also resulted in a significant reduction of the severity of CHF symptoms from levels 3-4 (sever) to levels 1-2.

The patients were given personal, weekly multi dose blister packs re-filled and sealed by pharmacists. The weekly blister packs were inserted into the SimpleMed+. The patients were followed up with weekly nursing phone calls and weekly refilled blister packs. This combined solution promises accurate medication consumption (taken on time and as prescribed).

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[1] Medication Adherence A Call for Action. Am Heart J. 2011 September ; 162(3): 412–424. doi:10.1016/j.ahj.2011.06.007.
[2] Telehealth for patients at high risk of cardiovascular diseases; BMJ 2016;353:i2647 http://dx.doi.org/10.1136/bmj.i2647
[3] Santa Helena study results, www.Vaica.Com