Improving Medication Adherence with Digital Health

Medication nonadherence – when patients don’t take their medications as prescribed – is fairly common, especially among patients with a chronic condition. To truly analyze and reduce adherence barriers, a shared responsibility lens must be utilized, placing collaborative care at the forefront.

Implications of nonadherence

For most chronic condition medications, adherence rates normally fall in the 50% to 60% range, (even for patients who have good insurance and drug benefits), and nearly one-quarter of new prescriptions are never filled. Unfortunately, this lack of adherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations per year in the United States.

Without a closed loop system to inform all stakeholders about patients’ adherence, costly medical complications abound. For example, nonadherence to prescribed treatment is estimated to cause $100 billion in preventable medical costs per year.

Adherence barriers

Adherence is complex and is influenced by many factors along the continuum of care, of which can relate to the patient, provider, treatment type, and health system. Specific examples include:

Patient-Related Barriers: Lack of motivation ; Lack of engagement in treatment decisions; Depression/ other mental health condition; Denia; Impaired cognition (e.g, related to aging or disease; Low educational level

Provider-Related Barriers: Barriers to communicating with patients and their caregivers; Complex dosing regimens; Limited coordination of care among multiple providers; Poor practitioner-patient relationship

Treatment-Related Barriers: Complexity of treatment; Side effects (or fear of side effects); Inconvenience; Cost; Time

Health System Barriers: Limited access to an appropriate provider for prescriptions or refills; Restricted drug coverage; High costs and co-payments; Unclear medication labeling and instructions; Inadequate provider time to review benefits, risks, and alternatives to prescribed medications

Extending adherence responsibility

Limited infrastructure exists to coordinate and communicate when a patient misses a dose, has an adverse reaction, or changes their medication. When patients fail to follow treatment plans, it’s often seen solely as a “patient” issue rather than placing responsibility on the health system or clinician.

For example, the REMIND trial compared the effects of 3 low-cost reminder devices on medication adherence in over 50,000 CVS patients, and found that the devices didn’t improve adherence among nonadherent patients. The REMIND trial concluded that the devices may have been more effective if coupled with interventions to ensure consistent use. 

Maintaining a connected, transparent healthcare experience is essential to paint the full picture of a patient’s medication-taking behavior. So, what might these interventions look like?

Increasing adherence via digital health tools

Digital health interventions allow for a comprehensive approach to medication management and fully support patients throughout their healthcare journeys. Promising efforts to improve adherence incorporate multiple strategies, including education, motivation, support, monitoring, and evaluation. In turn, these strategies reduce spending, streamline operations, and increase collaboration to improve adherence and long-term health outcomes.

Incorporating care coordination and care continuity to improve the pharmacist-patient relationship

Pharmacists’ efforts to improve adherence can positively impact patient care and generate substantial clinical and financial rewards. For example, in a recent study on acute coronary syndrome (ACS), patients assigned to team-based care were significantly more adherent with their medication regimen 12 months after hospital discharge (89%) compared with patients not receiving team-based care (74%). Methods included:

  • Pharmacist-led medication reconciliation and tailoring;
  • Pharmacist-led patient education;
  • Collaborative care between the pharmacist and primary care provider or cardiologist; and
  • Two types of voice messaging (medication refill and educational reminder calls).

Patient education and care coordination are critical for patient understanding and medication adherence. As highlighted in the ACS study, team-based care improves patients’ comfort in:

  • Asking clarifying questions;
  • Raising concerns about their medication regimen; and
  • Collaborating in developing their treatment plan.

Engaging initiatives to improve team-based care

Continually engaging, encouraging, and guiding patients can improve adherence to medication schedules. As such, digital health interventions that incorporate team-based care show major promise. In addition to supporting coordinated care, platforms should integrate engaging, personalized feedback and behavioral cues to keep patients on track with their treatment plans.

For example, certain mobile apps alert patients to take their medications (also known as a medication reminder) and track side effects. This is especially important for patients managing more than one chronic condition, since the greater the number of different medicines prescribed and the higher the dosing frequency, the more likely a patient is to be nonadherent.

Maximizing technology to document outcomes

If more information is known about a patient’s treatment, providers can better understand patient’s needs, identify and mitigate risks, and improve follow-up care. Therefore, when pursuing medication adherence initiatives, pharmacists should maximize technology to detect nonadherence and facilitate communication and therapy changes.

While engaging patients and healthcare teams is essential to successfully increase medication adherence, it’s also important to document and track intervention outcomes. Pharmacists should choose a digital health platform that has the ability to demonstrate the long-term value of therapies (adherence rates, clinical outcomes, revenue, cost savings, patient and team perceptions, etc.).

An example of this type of solution is Veta Health’s digital platform, which integrates patient-generated data with clinical data to gain insight into population-level performance and treatment outcomes. By collecting objective, real-time data, pharmacists can work with the patient on a more individualized level to discover information such as specific adherence barriers, care plan compliance, and side effects.

So, where does this leave patients now?

As former U.S. Surgeon General C. Everett Koop once reminded prescribers, patients and pharmacists, “Drugs don’t work in patients who don’t take them.” The healthcare system must acknowledge that failure to follow a medication regimen is widely recognized as a top reason for treatment failure. In addition to poor patient outcomes, medication nonadherence can lead to hospital readmissions and expensive treatments that drive higher downstream healthcare costs.

Using medication adherence tools not only enables patients to receive appropriate notifications, assessments and content information on a regular basis, but also accurately measures adherence, tracks adverse outcomes, and increases patient engagement. This, combined with digital health advancements and the technology that drives it, allows patients, providers, and pharmacists to be more in touch than ever before.


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