Report Card Shows Room for Rx Improvement

Medication adherence scores low among American adults with chronic conditions

/ Author:  / Reviewed by: Robert Carlson, M.D

The school year is over and many students are waiting to hear about their grades. But there's one report card we should all pay attention to — and it has to do with how well we're following our prescriptions.

The National Community Pharmacists Association (NCPA) released results from a survey on medication adherence in the United States. The survey — Medication Adherence in America: A National Report Card — found that many Americans with chronic (ongoing) conditions may not be taking their medications as prescribed.

The survey gave a C+ for medication adherence to adults 40 years of age and older with a chronic condition. And that C+ grade was just the average — one out of seven of these patients received an F.

"The academic year has drawn to a close for most students, but when it comes to taking their prescription drugs, it’s many of the parents who may require summer school," said B. Douglas Hoey, RPh, MBA, CEO of the NCPA.

"Proper prescription drug use can improve patient health outcomes and lower health care costs, so anything less than an A on medication adherence is concerning," Hoey said in a press statement. "Pharmacists can help patients and caregivers overcome barriers to effectively and consistently follow medication regimens. Indeed, independent community pharmacists in particular may be well suited to boost patient adherence given their close connection with patients and their caregivers."

In other words, any evidence that patients aren't taking their medications as they should is cause for concern, especially if those patients have a condition that requires treatment throughout their lifetime.

Because of their close relationships with patients and doctors, community pharmacists may be in a unique position to improve medication adherence.

What's the problem?

According to the NCPA report, a C+ is "a weak score particularly given the risks and costs of failing to take prescription medications as directed."

First and foremost, non-adherence (not taking medications as prescribed) can be damaging to patients' health. Patients who don't take their medication at all let their condition go unchecked, allowing it to progress and potentially to cause serious complications. If patients take too much or too little of their medication, they may not get the benefits of that medication or suffer harmful side effects.

On top of the harm it can lead to, non-adherence can add costs to the overall health care system. The cost of medication non-adherence amounts to an estimated $290 billion per year.

The survey and report card

To gain a better understanding of medication adherence, or lack thereof, the NCPA sponsored a survey of 1,020 adults at least 40 years of age with an ongoing prescription for medication to treat a chronic condition.

These participants answered whether or not they had engaged in the following non-adherent behaviors in the past 12 months:

  • Failing to fill a prescription
  • Failing to refill a prescription
  • Missing a dose
  • Taking a lower dose than prescribed
  • Taking a higher dose than prescribed
  • Stopping a prescription early
  • Taking an old medication for a new problem without talking to a doctor
  • Taking someone else's medication
  • Forgetting whether that had taken a medication

Report card grades were based on the average of participants' answers. Scores ranged from 0 to 100, with 0 meaning non-adherence on all nine behaviors and 100 meaning perfect adherence.

Survey results showed that, overall, respondents scored an average of 79, which amounted to that C+ grade.

Only 24 percent of survey respondents earned an A grade for being fully adherent to their prescriptions. Another 24 percent earned a B for being largely adherent, meaning they reported just one non-adherent behavior out of the nine total.

C and D grades were given to respondents who were somewhat non-adherent. In total, 20 percent earned a C grade for engaging in two of the non-adherent behaviors in the previous year and 16 percent received a D grade for engaging in three of those behaviors.

The remaining 15 percent of respondents received an F grade for engaging in four or more of the non-adherent behaviors. These largely non-adherent respondents represent one out of seven adults with chronic conditions, or about 10 million adults.

According to the authors of this report, the problem of medication non-adherence could be even worse than these findings suggest. That's because participants reported their own behaviors and may have been reluctant to admit to their non-adherent behaviors.

Why are patients not adhering to their medications?

In addition to providing rates of adherence, this report identified a number of factors that may predict medication adherence.

The strongest of these predictors was patients' personal connection with a pharmacist or pharmacy staff. Patients who were customers of neighborhood pharmacies felt most connected, followed by customers of large chains and those of mail order services.

A total of 89 percent of neighborhood pharmacy customers agreed that a pharmacist or pharmacy staff "knows you pretty well." In comparison, 67 percent of large chain customers and 36 percent of mail order customers agreed with that statement.

Other key predictors of medication adherence included the following:

  • How easy it is for patients to afford their medications
  • The level of continuity patients have in their health care — that is, whether or not they regularly see the same provider
  • How important patients feel it is to take their medication exactly as prescribed
  • How well informed patients feel about their health
  • How much patients' medications cause unpleasant side effects

Partnering up to improve adherence

According to the authors of the report, these predictors highlight a number of ways that health care providers and pharmacists can deal with the problem of medication non-adherence. Such tactics include better educating patients about the importance of adherence, improving the personal connection and communication between patients and their doctors and pharmacists, and encouraging patients to talk about medication side effects with their health care providers.

"Pharmacists have a role at the forefront of addressing prescription medication non-adherence," the authors wrote. "The results of this survey indicate that much depends on the extent to which pharmacists and pharmacy staff establish a personal connection with their customers and engage with them to encourage fuller understanding of the importance of taking medications as prescribed."

They added that independent, community pharmacists may be in an especially good position to boost medication adherence because they have a greater personal connection with their patients.

Mark Newberry, PharmD, is a prime example of one such community pharmacist. Newberry, who is the owner of Tarrytown Pharmacy in Austin, Texas, told dailyRx News, "Medication non-adherence is a serious problem. Diagnosing a condition and prescribing the appropriate medication is meaningless if the patient doesn't actually follow the regimen."

Newberry continued, "In the near future, we will begin to hear much more about how our pharmacists can play an integral role in helping our patients be more compliant with their therapies. Some pharmacists may see their patients multiple times per month, which makes the pharmacy a perfect venue to ask questions about how well their patients are doing regarding compliance."

The authors of the report also underlined the crucial role that health care providers play in the effort to increase adherence. They wrote that health care providers can stress the importance of taking medications as prescribed, help patients avoid or reduce unpleasant side effects of their medications and help patients stay informed about their conditions.

Furthermore, they wrote, both health care providers and pharmacists can do their part to reduce non-adherence by helping less wealthy patients find more affordable medication options.

"Better information, communication and patient support have been shown in previous studies to increase patients’ engagement and involvement in their health care, their satisfaction with their care and their loyalty to their health care providers," the authors wrote. "This survey shows yet another potential positive benefit of increased patient engagement — a reduction in the currently high levels of prescription medication non-adherence in the United States, and its associated costs and health risks alike."

Paul DelPonte, Director of Programs, Operations and Development for the National Alliance for Caregiving, also drew attention to the importance of strengthening partnerships between patients and caregivers.

"Caregivers are a vital resource for improving the national grade on proper prescription use," DelPonte said in a press statement. "Enhanced community partnerships and increased awareness on proper use of medications will make our nation healthier. This study by the National Community Pharmacists Association helps raise awareness of the issues facing caregivers and patients. It's time to improve this grade."

Review Date: 
June 23, 2013