2. Thesis Statement
• In order to affect better patient
outcomes, the burden of adherence
needs to shift away from solely the
patient to other stakeholders such as
physicians and pharmacists.
3. What is adherence?
• Adherence is “the extent to which a person’s behavior –
taking medication, following a diet, and/or executing
lifestyle changes, corresponds with agreed
recommendations from a health care provider.”1,2
• The reason this responsibility is left to the patients is
because, “it’s easier to blame patients and hold onto the
simplistic view that cost is the key drive, rather than to
understand the underlying symptoms that can lead to the
right interventions at the right time to increase
adherence.”6
1. Haynes, RB. (1979). Determinants of compliance: The disease and the mechanics of treatment. Baltimore MD,
Johns Hopkins University Press.
2. Rand, CS. (1993). Measuring adherence with therapy for chronic disease: implications for the treatment of
heterozygous familial hypercholesterolemia. American Journal of Cardiology, 72:68D-74D.
4. Another look at responsibility
• ”A significant barrier to effective medical treatment is
the patient's failure to follow the recommendations of
his or her physician or other healthcare provider.”12
• “Patients' health literacy is central to their ability to
adhere. ”12
12. . Martin, L., et al. (1 September, 2005). The Challenge of Patient Adherence; 1(3): 189–199. Clinical Risk
Management. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/citedby/.
5. Why are patients non-adherent?
• The five main reasons for non-adherence include9:
– Negative side effects
– Perceived under-performance of the product
– Complexity of the treatment regime
– No improvement noticed by patient
– Cost
9. Forissier, T. (April 2012). Patient Adherence: Initiating the Journey, 2(4), 26-28.
6. Does adherence matter?
Express Scripts Drug Trend Report. (2011). Nonadherence: New Insights. Retrieved February 26th,
2013, from http://www.drugtrendreport.com/insights-and-solutions/nonadherence-new-
insights/more-than-patient-education.
7. What are the numbers?
• Adherence to long-term therapy for chronic illnesses in
developed countries averages 50%.1,5
– Rates are even lower in developing countries.
• Non-adherence costs the U.S. health care system
between $100 billion and $289 billion annually.11
• Estimates of hospitalization costs due to medication non-
adherence are as high as $13.35 billion annually in the
US alone.11
1.Haynes, RB et al. (2001). Interventions for helping patients to follow prescriptions for medications. Cochrane
Database of Systematic Reviews, Issue
5. Sacket, D. et al. (1978). Patient compliance with antihypertensive regimens. Patient Counselling & Health
Education, 11:18-21.
11. Viswanathan, M. et al. (December 2012). Interventions to Improve Adherence to Self-administered Medications for
Chronic Diseases in the United States: A Systematic Review. Annals of Internal Medicine.;157(11):785-795.
8. How does being adherent save
money?
• Higher rates of adherence contribute to economic
benefits8
– “Direct savings caused by reduced use of sophisticated and
expensive health services needed in cases of disease
exacerbation, crisis or relapse.”8
– “Indirect savings may be attributable to enhancement or
preservation of, quality of life and the social and vocational
roles of the patients.”8
– Reduction in the numbers of patients being hospitalized,
days in the hospital and outpatient visits.7
• Cost to savings ratio of approx. 1:10 over a 3 year study
7. Sloss, EM et al. (2000). Selecting target conditions for quality of care improvement in vulnerable older
adults. Journal of the American Geriatrics Society, 48:363-369.
8. World Health Organization. (2003). Adherence to long-term therapies: evidence for action. WHO
publications.
9. Specific savings
• Pharmacy costs for all
prescriptions filled, ranged
from $2,867 to $3,780 per
patient per year.10
• Annual medical spending
was significantly lower for
adherent patients.
• Savings are mainly through
reduced inpatient hospital
days and emergency
department visits.
10. Roebuck, M. C., Liberman, J. N., Gemmill-
Toyama, M., & Brennan, T. A. (2011). Medication
adherence leads to lower health care use and costs
despite increased drug spending. Health
Affairs, 30(1), 91-9. Retrieved from
http://search.proquest.com/docview/847269644?acc
ountid=29001
Disease
state
Total
health
care
costs
Average
annual
medical
spending
Annual
per
person
savings
Congestive
heart failure
$39,076 $8,881 $7,823
Hypertension $14,813 $4,337 $3,908
Diabetes $17,955 $4,413 $3,756
Dyslipidemia $12,688 $1,860 $1,258
10. Positive impact on patient health
“Increasing the effectiveness of adherence interventions
may have a far greater impact on the health of the
population than any improvement in specific medical
treatments.”3
3. Haynes, RB et al. (2001). Interventions for helping patients to follow prescriptions for medications. Cochrane Database
of Systematic Reviews, Issue 1.
11. Tackling The Problem
• Objectives
– Determine general attitudes on whose responsibility it is for
patient adherence.
– Determine reasons for non-adherent behavior.
– Research tactics and effectiveness of those tactics to
increase patient adherence.
• Subjects
– Healthcare Professionals
• Pharmacists
• General Practitioners
• Specialist Physicians
• Nurses/Physician Assistants
– Patients (M/W aged 30+)
12. Where do we find them?
• Healthcare professionals
• Web-based survey (Surveymonkey.com)
– Fielded through affinity groups on LinkedIn
» 61 responses (26 complete)
» Patient Adherence Solutions
» Patient Adherence, Compliance & Communication
Strategy for Pharma
» Pharmacists
» Therapy Compliance
• Patients
– High traffic area intercepts & web posts
• 33 responses
• Survey link (Polldaddy.com)
17. HCPs speak out about patient
non-adherence
• Healthcare providers reasoning for why they believe
patients are not adherent 100% of the time.
– “They are not properly educated on their medications.
Doctors skip this part.”
– “They are hard headed, they diagnose and treat their selves
according to hearsay.”
– “It is socioeconomic, belief systems, and education that are
variables in this equation.”
– “I have noticed several patients that feel like giving up. They
are overwhelmed with the amount of medications that are
thrown at them on a regular basis without any non
pharmacological alternatives. Other patients have time
constraints or, being human, they just forget.”
18. HCPs speak with their patients.
• HCPs say the topic of adherence is brought up very
often by their patients that are taking medication.
19. We can all get along
• Patients & HCPs agree, the burden of taking
medication is primarily on patients.
– Burden of actually taking medication should stay on patient
but education should be provided by HCPs.
– The responsibility of adherence needs to be a multi person
effort that includes HCPs.
20. Team efforts drive steps towards
a solution
• Patients trust their HCPs knowledge and skills.
– General Practitioners and Specialist Physicians are most
impactful following the patient.
• Utilize this relationship to convey knowledge to patient, so
they understand their medication regime and importance.
• HCPs need to devote time to addressing patient
concerns and stressing importance of adherence.
21. Sources
1. Haynes, RB et al. (2001). Interventions for helping patients to follow prescriptions for medications. Cochrane
Database of Systematic Reviews, Issue
2. Haynes, RB. (1979). Determinants of compliance: The disease and the mechanics of treatment. Baltimore
MD, Johns Hopkins University Press.
3. Rand, CS. (1993). Measuring adherence with therapy for chronic disease: implications for the treatment of
heterozygous familial hypercholesterolemia. American Journal of Cardiology, 72:68D-74D.
4. Express Scripts Drug Trend Report. (2011). Nonadherence: New Insights. Retrieved February 26th, 2013,
from http://www.drugtrendreport.com/insights-and-solutions/nonadherence-new-insights/more-than-patient-
education.
5. Sacket, D. et al. (1978). Patient compliance with antihypertensive regimens. Patient Counselling & Health
Education, 11:18-21.
6. Minoff, R. (1 November, 2012). It’s Time to Put On Your Thinking CAP. PM360. Retrieved February 26th,
2013, from http://www.pm360online.com/its-time-to-put-on-your- thinking-cap/.
7. Sloss, EM et al. (2000). Selecting target conditions for quality of care improvement in vulnerable older adults.
Journal of the American Geriatrics Society, 48:363-369.
8. World Health Organization. (2003). Adherence to long-term therapies: evidence for action. WHO publications.
9. Forissier, T. (April 2012). Patient Adherence: Initiating the Journey, 2(4), 26-28.
10. Roebuck, M. C., Liberman, J. N., Gemmill-Toyama, M., & Brennan, T. A. (2011). Medication adherence
leads to lower health care use and costs despite increased drug spending. Health Affairs, 30(1), 91-9. Retrieved
from http://search.proquest.com/docview/847269644?accountid=29001
11. Viswanathan M. et al. (December 2012). Interventions to Improve Adherence to Self-administered
Medications for Chronic Diseases in the United States: A Systematic Review. Annals of Internal
Medicine.;157(11):785-795.
12. Martin, L., et al. (1 September, 2005). The Challenge of Patient Adherence; 1(3): 189–199. Clinical Risk
Management. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/citedby/.
