Americans Not Making the Grade on Medication Adherence

Megan Brooks

June 25, 2013

When it comes to taking their medicine for chronic conditions as prescribed, Americans earn only a C+ on average, and 1 in 7 receive a failing grade, according to the first national report card on medication adherence, released today.

"Anything less than an A on medication adherence is concerning," B. Douglas Hoey, RPh, chief executive officer of the National Community Pharmacists Association (NCPA), which commissioned the survey, said during a press conference.

According to the report, millions of adults aged 40 years and older with chronic conditions are departing from physicians' instructions in taking their medications: skipping, missing, or forgetting whether they have taken doses; failing to fill or refill prescriptions; under- or overdosing; or taking medication prescribed for a different condition or to a different person.

"Poor adherence," said Hoey, "may be the most deadly, most costly, and yet most preventable action that can make patients healthier. The costs of nonadherence are estimated at $290 billion dollars annually."

Physicians, other healthcare providers, and pharmacists have a vital role to play in stressing the importance of taking medications as prescribed, in monitoring and helping patients avoid or reduce unpleasant adverse effects that may compromise adherence, and in helping keep patients more generally well-informed about their health conditions, he added.

10 Million Adults Get a Failing Grade

The survey, conducted by Langer Research Associates, included a national sample of 1020 adults aged 40 years and older who have received a prescription for a chronic medical condition, most commonly hypertension and hypercholesterolemia.

The researchers calculated grades on the basis of an average score of answers to questions on 9 nonadherent behaviors: whether in the last 12 months patients failed to fill a prescription, neglected to have a prescription refilled, missed a dose, took a lower dose than prescribed, took a higher dose than prescribed, stopped a prescription early, took an old medication for a new problem without consulting a physician, took someone else's medicine, or forgot whether they had taken a medication.

The survey found that Americans earn only a C+ grade on average in terms of taking their medication properly. One in 7 adults with chronic conditions — the equivalent of more than 10 million adults — receive an F grade. Collectively, one third of overall respondents received a grade of either D or F.

"Any nonadherence is troubling, given the personal consequences and costs, and this is a fairly dispiriting result," said Gary Langer, president of Langer Research Associates. If anything, he added, the poor grades seen in this survey "understate" the problem of nonadherence because of the self-reported nature of the answers and potential reluctance among some individuals to admit to not taking their medication.

About three quarters of those with a chronic condition surveyed did admit to at least 1 nonadherent behavior in the past 12 months, and more than half reported multiple forms of noncompliance. The average is approximately 2 types of nonadherent behavior per patient.

Nearly 6 in 10 Miss Doses

By far, the most common form of noncompliance was missing a dose of a prescribed medication, reported by nearly 6 in 10 of those surveyed.

Thirty percent reported forgetting whether they had taken their medication, and 28% said they failed to refill a prescription medication in time. About 2 in 10 said they have taken a lower dose than instructed (22%) or did not fill a new prescription (20%), and 14% admitted to going off their medication without consulting their physician.

According to the survey, the biggest predictor of medication adherence was patients' personal connection (or lack thereof) with a pharmacist or pharmacy staff. Patients of independent community pharmacies reported the highest level of personal connection (with 89% agreeing that pharmacist or staff "knows you pretty well"), followed by large chains (67%) and mail-order pharmacies (36%).

Affordability of medications was also a big factor in adherence, with nearly a third of those surveyed saying they had difficulty paying for their medications. Other predictors (in order of importance) were continuity in healthcare use, how important patients feel it is to take their medication as prescribed, how well informed they feel about their health, and medication adverse effects.

Path to Better Adherence

"This survey not only establishes the breadth of the problem but evaluates factors that influence medication nonadherence, suggesting paths to attempt to address the problem," the report states.

"Avenues for increasing prescription medication adherence are apparent, if perhaps challenging to implement. Among them: Giving patients access to the resources they need to better understand their health, stressing the importance of taking medications exactly as prescribed, encouraging pharmacists and pharmacy staff to establish a personal connection with their clients and increasing continuity in patients' health care relationships," the report notes.

The report also challenges healthcare providers and pharmacists to work with patients to find medications that are more affordable, perhaps through coupons, discount programs, or the use of generics, as a way to boost adherence.

The survey is part of the NCPA's Pharmacists Advancing Medication Adherence initiative, sponsored by Pfizer, Merck, and Cardinal Health Foundation.

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