Tuesday, November 1, 2011

Advancing Medication Adherence

Adherence to medications is still a tough challenge according to William Shrank, MD, Director of Evaluation for the CMS Center for Medicare and Medicaid Innovation speaking at Partners Healthcare’s Connected Health Symposium held October 20-21, 2011 in Boston. Dr. Shrank pointed out that patients adhere 50 to 70 percent of the time in taking their essential medications for chronic conditions.

The average user taking a medication to lower their blood pressure also takes a number of additional medications to maintain all of their chronic conditions. The barriers to full compliance can include problems such as understanding how to use the medication and understanding affordability and coverage factors. Physicians need to be able to communicate knowledge on drug costs, medications safe use, and be familiar with their patient’s medication adherence. In addition, at the system level, there needs to be information on access and coverage of medications, administrative barriers, and additional information on health IT.

Health IT interventions are promising tools in the fight to improve medication adherence. However, while many studies have been done to boost medication adherence, very few have been done on using health IT to accomplish this goal. So while promising results are available, even more research needs to be done.

Dr. Shrank explained that with the explosive growth in e-prescribing, it is now possible to identify patients who fail to adhere in real-time, find patients who fail to initiate prescriptions, communicate with providers and pharmacists when patients fail to adhere, predict which patients are at risk for non-adherence, link medical and pharmacy information to the largest groups of high risk patients, and send out electronic reminders.

Social networking is another major advancement to help people deal with their medication regime and is proving to be very effective with great potential for the future. For example, Dr Shrank as the author of a landmark study on the health uses of Face Book by patients with diabetes, points out that social networking can provide diabetic patients with a rich community of emotional support by enabling the diabetic community to share personal stories and learn from each other.

According to Dr. Shrank, “To be effective we need to make better use of data, need to provide real incentives to reward adherence to medications, and do a better job of benefit design. The Post-MI FREEE trial due to be published soon is geared to patients with coronary artery disease. The trial was designed to evaluate the effect of providing full prescription drug coverage for some drugs and will be the first randomized study to evaluate the impact of reducing cost-sharing for essential cardiac medications in high risk patients on clinical and economic outcomes.

For more information on the Symposium, go to www.connected-health.org.