Pushing adherence key with chronic conditions

NEW YORK —A look at the animated map on the Centers for Disease Control and Prevention’s Web site is staggering: Whereas obesity rates in the 1980s were less than 20% in all 50 states, only Colorado has such a rate today.

The increase in obesity brings with it an increase in such associated chronic diseases as Type 2 diabetes, heart disease and hypertension, which the Milken Institute projected will increase by 40% to 50% over the next 15 years. That, in turn, has led to an increase in the need for medications to treat those diseases.

The problem is that many patients don’t take their medications as directed, especially in the recession.

According to the National Association of Insurance Commissioners, the bad economy has led to 22% of patients making fewer doctor visits, while 11% have scaled back or reduced dosage on prescription drugs. This, however, opens the door to opportunities for supermarket pharmacies.

“The most successful interventions are designed to maintain a series of connections with patients over time,” pharmacy marketing firm Catalina Marketing group VP business development Sharon Glass told Drug Store News. “They often integrate a combination of counseling, automated call outs and print communication to remind patients of why and when they need to renew their prescriptions.”

Concurrent conditions create complexitySource: Catalina Health Resources PatientLink(Catalina Marketing analysts looked at data from the company’s PatientLink system for patients who began new therapies to treat those conditions in July 2008 and followed them until July 2009. They also looked at data for the 180 days prior to July 2008 to make sure the patients were not on those therapies before July 2008.)

THERAPEUTIC CATEGORY	% OF PATIENTS ALSO FILLING Rx FOR OTHER CATEGORIES
CHOLESTEROL	TYPE 2 DIABETES	HYPERTENSION
Cholesterol	100%	43%	30%
Type 2 diabetes	21	100	15
Hypertension	57	57	100

In one study of more than 190,000 patients, Catalina found that those taking medicines to treat chronic disorders showed a persistent decline in compliance after the first refill, with 70% of compliance after one refill, but less than 15% after the 12th, though some of that occurs due to patients switching retailers or using mail-order pharmacies. Glass presented findings from the study at the FMI Supermarket Pharmacy Conference in September.

But other factors can influence noncompliance, such as complexity of treatment regimens, particularly those that require multiple medications and involve multiple conditions—as many as 57% of patients taking drugs for hypertension, for example, also take drugs for Type 2 diabetes.

“Compliance trails off over time for several reasons: Some cannot afford their medications, many just forget to get them refilled and some are bothered by side effects,” Glass said. “When you think about chronic, asymptomatic conditions like high cholesterol, one of the biggest opportunities is to remind these patients about the reasons they need to take their medications as directed, even when they cannot tell what effects that medication is having until they have their next blood test.”

But pharmacies can influence most of the attitudes that lead patients toward noncompliance, such as forgetfulness, lack of concern for conditions, lack of information about the drug or the disease it treats, and unpleasant side effects.