Consider a New Approach to Improve Medical Adherence

Posted by Pharmacist on November 26, 2012

In 2008 Medco Health Solutions Inc. reported that 51% of insured Americans took at least one medication for a chronic health condition, but as many as 50% of those same people weren’t taking their medications as prescribed, according to a recent American Society of Health-System Pharmacists (ASHAP) article. That same article notes a 2009 report from NEHI (formerly the New England Healthcare Institute) that said poor adherence is a “drug-related problem” that can be responsible for as much as 13% of total health care costs – which adds up to $290 billion per year in unnecessary spending.


The ASHAP article cited a presentation from Bruce Lambert who discussed the psychological issues of personal self-image, motivation and how a chronic illness diagnosis can affect personal choices. Lambert is a clinical professor of pharmacy practice at the University of Illinois in Chicago; he spoke at an Agency for Healthcare Research and Quality conference in September 2012. He said “”Our paradigm for understanding what motivates [patients] is just completely wrong. What really motivates people is this desire . . . to hang onto some preferred sense of self. If medicines help with that, people will take them. And if they don’t, they won’t.”


It’s a mistake to assume patients are just forgetting to take their medication as prescribed according to Cynthia Rand, a professor of medicine at Johns Hopkins University in Baltimore who is quoted in the ASHAP piece. She said that many patients who have chronic illnesses may not fully believe they need daily medications for the rest of their lives.


According to Lambert, to help increase patient medical adherence the medical community needs to help patients understand their medications are a step in restoring their self-identity. Because some medication therapies may result in physical changes that threaten self-image (impotence from antihypertensive drugs was cited as an example) it’s key that medical professionals move from “a purely biomedical model of medication adherence.”


Rand agrees and says that it’s important for the medical community to shift away from the top-down models of adherence and compliance that lay the blame on and “punish” patients who do not take their medications as prescribed since these strategies don’t take individual factors into consideration.


There are initiatives to help the medical community work with patients to increase adherence such as the Script Your Future campaign from the National Consumers League. The Center for Medicare and Medicaid Innovation and The National Institutes of Health offer grant funding to help develop new approaches to improve adherence.

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