Diverse coalition issues new guidelines to boost patient compliance, outcomes

WASHINGTON The ongoing effort to improve patient medication compliance and health outcomes gained new traction with the release this week of a set of policy recommendations by a diverse coalition of healthcare and consumer organizations.

The group — which includes the National Association of Chain Drug Stores, the American College of Cardiology, GlaxoSmithKline, the National Consumers League and the Pharmaceutical Research and Manufacturers of America — issued the new guidelines to promote better medication adherence and improved health outcomes for patients as Congress debates different aspects of health reform legislation. Their recommendations focus on quality improvement, coordination of care, health information technology, engaging and educating patients and health providers, and health services research.

The new initiative comes amid rising concern over the toll taken by patient noncompliance, both in terms of human health and dollars wasted. According to a 2005 study published in the New England Journal of Medicine, an estimated one-third to one-half of all patients in the United States do not take their medications as prescribed.

“The impact of this nonadherence is costly in terms of both quality of care and cost. In fact, recent research including work by New England Healthcare Institute (NEHI) and a 2004 study published in Medical Care suggested that costs resulting from nonadherence may be as high as  $300 billion annually,” noted the group in a joint statement.

“Not only is poor medication adherence costly, but it also can be dangerous,” said Sally Greenberg, executive director of the National Consumers League. “Because patients don’t take their medications for a variety of reasons, including cost, such as copays and deductibles, side effects, misconceptions or fears, and trouble with administration, we need to employ a multitude of strategies to improve adherence. Our efforts are focused on identifying key opportunities to improve the health care system and reduce barriers that keep patients from getting the best benefit from their medicines.”

The coalition’s recommendations were hammered out after a July conference that featured more than 40 medication adherence experts, including providers, patients, payers and academics. The dialogue was informed by two research presentations by RAND Corporation, which provided a literature-based framework to help guide the creation of the policy recommendations, and Avalere Health, which described here-and-now programs to improve medication adherence.

Among the group’s specific proposals:

• Quality Improvement – National quality improvement strategies should explicitly recognize medication adherence and appropriate medication use as critical components to improve healthcare quality and clinical outcomes.
• Care Coordination — Proposals aimed at improving care coordination must recognize the important role that medications play in treating and managing illnesses.
• Health IT — Health IT must improve the flow of timely and complete information between patients and providers, and enable providers and payers to identify and address gaps in patients’ medication use.
• Patient/Provider Education and Engagement —Strategies to improve medication adherence must fully engage patients, and patient-centered care must involve strategies to help them better understand their conditions and treatments, the coalition urges. “These efforts also must support providers in effectively communicating the importance of following treatment plans, and in providing medication support services to patients and caregivers,” noted the group.
• Health Services Research — “There is a need for additional research on medication adherence, including a focus on the effectiveness of a wider range of interventions to improve adherence, as well as an analysis of the diverse factors, behaviors, costs and consequences related to poor adherence,” the coalition noted in a statement.

“Medical adherence is a problem that should unite all providers, elected officials, pharmacists, insurers and pharmaceutical companies,” said Jack Lewin, CEO of the American College of Cardiology. “Fifty percent of patients with heart disease are not taking their potentially life—saving medications, but it is our hope that recommendations like these will go a long way toward addressing this serious problem.”

For more information, or to endorse the proposals, contact Colette Desmarais at [email protected].