MEDICATION ADHERENCE AND COMPLIANCE

According to the Office of the U.S. Inspector General, “Non-compliance with drug treatment accounts for
125,000 deaths per year. 10% of hospital admissions and up to 23% of nursing home admissions each year could be avoided if people took their medications as prescribed. Neither gender, age, ethnicity or educational level seem to be an indicator of compliance.”1

According to the Geriatric Times, “medication misadventures are endangering the health of the geriatric population, filling emergency rooms and hospitals, and contributing to escalating health care costs. Polypharmacy, wherein elderly patients must manage compliance with regimens of several prescription drugs and concurrently may be self-medicating with over-the-counter (OTC) products, should be of concern to all members of the health care team who work with geriatric patients.”2

The medical profession defines compliance as the degree to which a patient follows a treatment plan. Studies have shown that only 50% of patients take their medications as prescribed. 3

Reasons for non-compliance are varied and include:

• Inconvenience
• Not understanding the instructions
• Fear of possible side effects
• The taste of medications and altered taste perceptions of other foods
• Cost – one third of Medicare patients have no prescription coverage
• Personal and emotional (psychosocial) reasons, such as such as denial of illness or an attempt to gain control

Compliance is an issue for all age groups. The elderly have multiple compliance issues including: numerous medications ordered by different doctors and use of non-prescription drugs, increased sensitivity to medications and cognitive changes. Middle-aged adults are at greatest risk for missing medications due to their busier lifestyles. Children are less likely to follow a treatment plan especially with a chronic diagnosis that requires complex therapy such as asthma and juvenile diabetes. Adolescents can refuse treatment out of rebellion towards parents or authoritative medical personnel.

There is no single cause of non-compliance, so preventing it can be challenging. Recommendations include:

Encouraging routines/use of medications that are associated with certain events or a time of day

• Providing printed instructions that are simple and easy to follow. Most medication instructions are at the eighth grade reading level, which only 58% of the population can easily read. 4
• Recommending devices such as pill boxes
• Fostering two-way communication with patients, and providing clear explanations and the rationale for treatment
• Encouraging support groups or a family member or “buddy” to assist your patient in reinforcing their treatment plan

Gateway is interested in partnering with your office to meet the many challenges of medication and treatment compliance. At Gateway, we have a number of resources available to provide assistance to your office with regard to adherence to treatment plans, including medication compliance.

Gateway’s “Special Needs Unit” (SNU) is designed to provide special assistance to members who may need guidance in following their medication regime or their treatment plan, or to connect them with supportive community resources

Services provided by the Special Needs Unit include the following:

Assistance with medication compliance

• Education and support for treatment plan adherence
• Linkage to community resources
• Assistance with coping skills
• Linkage to Behavioral Health Services
• Assessment of health risks
• Telephonic support for a family in need
• Assessment of Safety in the Home
• Linkage to Medical Assistance Transportation Services

The Special Needs Unit can be contacted at 1-800-642-3550 Option 1, Monday through Friday, between the hours of 8:30am and 4:30pm to refer one of your patients for any of these services.

We look forward to hearing from you as we work toward a common goal – the improved health and well being of the patients we serve.

References:

1Merck Manual – Home Edition – Section 2 , Chapter 11
2Geriatric Times, September/October 2000, Volume I, Issue 3
3Compliance and Compromise, Volume 2, No. 5, Sept/Oct 2001
4Royfal Issue Brief – Issue #5, Center on Aging and Cognition: Health, Education, and Training, Spring 2002