Are we over-relying on patients? Patients often think once they receive a prescription, their medication journey is complete. Unfortunately, picking up a prescription is only a small part of a medication journey and patient health outcomes often hinge on more complicated factors. And the results could be devastating. ConnectiveRx’s podcast series, The Science of Medication Access: Is It Working?, explores the complexities of patient health beginning with medication adherence, asking is medication access really working?
In this article, we share some of the most salient highlights from the first two episodes in the podcast. The first episode, “Unmasking Non-Adherence with Grace Lomax” reveals the startling truths about the prevalence of patient nonadherence and just how tremendous an impact increases in adherence could be—and simple steps marketers and brands can take to vastly improve adherence.
The second episode, “Empowering Communities: Pharmacists’ Crucial Role in Patient Health” dives into how pharmacies are evolving to expand the point of care, and ultimately transform patient health journeys and patient support.
Let’s take a look at how both these topics align around driving better medication adherence, patient access, and ultimately stronger health outcomes through patient engagement.
Table of Contents
Adherence: A Strategic Cornerstone and Healthcare Calling
Nonadherence affects every type of condition and patient demographic area, including children and oncology. Overriding medical reasoning, patients have obstacles to adherence, some of which are intentional and others which are not. In the first episode, “Unmasking Nonadherence with Grace Lomax”, the surprising prevalence of nonadherence across therapeutic areas is set bare:
"The data speaks loud and clear that non-adherence is a problem in every therapy area, no matter the morbidity, and also across all ages. And that isn't the patients being naughty, mischievous, defiant—it is the patients lacking understanding, not being able to afford it [medications], fear of addiction, intolerable side effects. There are a plethora of reasons that patients are nonadherent. The problem is, it is at such a scale it's industrial. This means that patients are not benefiting from treatment, despite everyone thinking they're on the treatments."
Even for patients with medication in hand, adherence can still be a massive problem. A patient who does not take their prescriptions as directed, can seriously risk their health and skew understanding on medication effectiveness for healthcare practitioners and brands.
The podcast, hosted by Joanne Biscardi, calls on industry professionals to consider the entire prescription journey and reconsider where adherence fits into their strategies. Beyond Rx access, how well patients are taking and continuing their prescriptions is central to our shared goals of better outcomes and longer lives.
It also explores other areas beyond medication access, like new and expanding points of care in the second episode. The expanded look beyond RxAccess explores the larger context of how we, as an industry, enhance patient education and health outcomes.
Everyone is At Risk: The Facts About Nonadherence
The Extent of Nonadherence
The prevalence is shocking, even among those who butter their bread in healthcare. More globally, we all face the tragic reality that the medicines that could save our lives can be rendered ineffective because of totally mendable behaviors and knowledge gaps.
Even with common drugs that are needed, nonadherence can imperceptibly work behind the scenes to shorten the length of life or decrease health outcomes regardless of whether someone feels symptomatic. Heart disease, which will contribute to the death of 1 in 2 (1,700,000) people and is the leading cause of death for Americans (CDC), is among those silent corrosives that wear away at patient health.
Dr. Lomax provides more context on the severity of the issue by looking at hypertension, specifically:
"There are about 450 million prescriptions for antihypertensives in America each year. That is the scale at which hypertension is managed. And yet we know in America that 70% of hypertensive patients are non-adherent to their medicines, and there are real consequences to that."
Despite technically being “treated,” 80% of hypertensive patients in America do not achieve normal blood pressure. Nonadherence is a major contributor, according to Lomax, improving adherence could reduce related deaths by 13% every year.
Dropoff After Pick-up: Rx Non-Adherence
Aside from the heart-stopping number of people not picking up medications at all, people are not very adept at following through on taking medications for a plethora of reasons we’ll cover next.
There are two main types of nonadherence Dr. Lomax draws attention to that healthcare can address:
- Straightforward non-persistence, wherein “patients aren’t even coming back. They have run out of medicine and have stopped.”
- Poor adherence with long gaps between refills where “far too long a gap” goes between prescriptions, showing medications are not being taken as directed.
Unfortunately, healthcare providers other than pharmacists do not have visibility into prescription fill history, so the latter can go entirely unnoticed, with patients not always accurately reporting that they’ve missed or delayed scheduled doses.
Both scenarios result in patients not benefitting from their medicine, causing progression of the condition, ongoing symptoms, or potentially life-altering consequences or death.
Each type of nonadherence should be addressed by better tracking, supporting, and engaging clients around medication regimens and barriers. Even in pediatrics, where parents are deeply concerned about successful patient outcomes, barriers and misconceptions can harm patients unintentionally. It can be especially hard for patients experiencing either no symptoms, or very hard to cope with side effects. Without properly identifying each patient’s challenges or concerns, nonadherence will persist as a default response to obstacles.
Why Aren’t Patients Taking Their Medicine: Fear and Misconceptions
People seeking medical attention want to be well. So why aren’t they taking their medications after all the effort of getting a script? Several factors to nonadherence show up routinely in Dr. Lomax’s studies:
- Polypharmacy and complex drug regimens: Dr. Lomax notes, “The average 65 year old and up retiree is being treated for three different diseases, with typically five or more medicines and we’ve worked with some teams where the patients are on 15 different medicines.”
- Lack of knowledge and health literacy gap: Patients often don’t understand the importance of their medications or how to take them properly.
- Cost concerns or affordability: As mentioned in the American Medical Association piece cited in the podcast, affordability is a significant barrier to adherence.
- Fear of side effects: Patients may be hesitant to take medications due to concerns about potential adverse effects.
- Mistrust in the healthcare system: Some patients may be skeptical of medications due to concerns about pharmaceutical marketing or doctor-industry relationships.
- Worry about addiction or tolerance: Many people, according to Lomax, are afraid of becoming addicted to their medications, especially for long-term medications.
“There’s also a concern and myth [that if people]… stay on [medication] for an extended period they will become addicted to it and will be unable to stop it if they want to.”
According to a survey Clarivate conducted on people leaving hospitals, “63% of the population worry about tolerance of the medicine if they stay on it for long.” That can lead to a sort of hoarding and nonadherent misuse of the medication.
“The fact is that they worry that the medicine will become less effective if they keep taking it, so there's an inkling to keep it for when they need it."
In truth, even though almost two-thirds of the population worry about medication addiction or tolerance, “There are only two classes of drugs that are addictive out of the 1000s of classes and treatments out there.” Yet the widespread anxiety around long term adherence to medicine persists, which is something medication education and patient communication can change.
Proof of Life: Adherence Efforts Matter
The responsibility for medication adherence cannot fall solely on individual patients or particular practitioners. The larger healthcare industry can foster adherence. By investigating the industry-wide implications of non-adherence, “Unmasking Non-Adherence” underscores the urgency for innovative solutions.
With the rise of so many chronic or long-lasting conditions, ongoing patient education and adherence are vital for proving the effectiveness of prescriptions and creating holistic improvements in human lives. When patients are driven by accessibility, fear, or misconceptions to incorrectly or intermittently use medications, our society and its members suffer needlessly. Someone dies of a heart attack every 40 seconds. That is over 800,000 Americans every year—many of whom could have been on life-saving medication. A quarter of those deaths are the result of a subsequential heart attack. (CDC) Would taking their meds correctly have saved the life of a firefighter, a parent, or an educator?
Small Changes in Adherence Can Save Lives
How can small changes in adherence lead to life-saving outcomes? Let’s explore a powerful case study in mental health that demonstrates the significant impact of seemingly minor improvements in medication adherence.
As a case study in impact, Lomax points to mental health on how significant the nonadherence problem is and how significant potential and simple solutions are.
In the United States, says Lomax, there are more prescriptions for depression than there are people. Yet half of all depressed people stop taking their medications prematurely, within six weeks. They are not magically better. There are nearly twice as many suicides (48,000) as homicides (CDC) in the United States every year, with the vast majority of those being due to depression. That is not to underplay that the impacts of depression outside suicide severely impact the quality of life and functioning.
Even considering the possibility that a portion feels asymptomatic after a single Rx fill:
“If you can get a depressed patient to go from just their first script to collecting their second... you reduce by 300% the likelihood of them committing suicide. 300% reduction in suicides if we go from one to two prescriptions. Such a low but important hurdle?”
To show the impact healthcare marketers and brands can make, Lomax shares a case study in which Clarivate ran a campaign with 1.5 million moderately to severely depressed patients over about 18 months, improving adherence by 29%.
Strategic Interventions: How Brands Can Champion Patient Rx Adherence
Interventions that are holistically and community-supported by things like point of care, pharmacy, and other environmental education can be simple and highly effective:
- Take time to understand the patient’s needs: Dr. Lomax asks us to really examine what is meant by patient centricity outside the hype, “The purity of what should be patient-centricity is having the patient’s needs at the center of what you do.” Listen to first-hand feedback and continually and proactively gather patient perspectives.
- Go beyond measuring needs and behaviors: Integrate patient perspective, experiences, and qualitative feedback directly into patient-centered and actionable strategies. Create support and education that extends throughout Rx journeys.
- Address patient-needs explicitly: Develop targeted interventions based on identified barriers to adherence. Reach out to communities, networks, and caregivers who can support patient education and needs.
- Look at the big picture and doggedly humanize: Remember that they are not our “patients”, but a person on a medicine, and often on many medications. Dr. Lomax advises, “We think of patients as ‘our’ patients. So a patient is on Metformin, let’s say. But in fact, they’re a person who’s on a medicine, and very often they’re a person who’s on many medicines.”
- Develop clear, concise educational materials: As Michelle Chartier from Stop and Shop pharmacy suggests, “Simplified handouts for our patients to really help reinforce the pharmacist recommendations that we want them to get protected today.”
Pharmacy: Patient Health Allies Expand POC Options
In ConnectiveRx’s second episode in their series The Science of Medication Access: Is It Working?, they dive into the pharmacy—a growing area where local action and point of care engagement can remedy poor patient adherence. As a powerful in-person and digital POC, the local pharmacy can triage accessibility with in-person, print, and digital education, products, and services. Below are some highlights of the panel discussion.
Pharmacies: Accessible Allies in Patient Care
Pharmacies have become indispensable allies in patient care and adherence. With extended hours, no appointments necessary, and a presence in nearly every community, they offer unparalleled accessibility. This convenience is crucial for timely care and can significantly boost patient adherence to treatment plans.
Ranking most-trusted among healthcare providers patients routinely see, the trust patients place in their pharmacists, combined with the ease of access, creates a potent antidote for nonadherence.
Pharmacies have unique tools and advantages that set them apart in healthcare delivery:
- Access to Rx fill history
- Rx synchronization programs
- Walk-in and short-wait vaccination and clinical services
"Access to prescription fill history and tools such as medication synchronization programs allows us to make measurable impacts on patient adherence."
Especially with regularly visited or in-store pharmacies, pharmacists and staff can readily address a number of barriers and create solutions in the course of everyday patient life, lifting adherence.
Pharmacies employ a variety of strategies and POC tactics to improve adherence, such as:
- On-hand integration of retail and OTC health and other forms of symptom or side effect management
- References and resources for patients on conditions, treatments, and care providers
- Help with affordability
- Omni-channel and in-person communications around health education, like CDC recommendations, and ad hoc health questions
- Tracking, monitoring, and intervention tools, including digital apps, reminders, and punch cards
- Leveraging patient-pharmacist relationships and observations on lifestyle or indications that support may be needed
As Couture emphasizes in the podcast: “Research shows that a recommendation from a healthcare provider is the number one reason a patient chooses to vaccinate.” Reinforcing pharmacy services, physicians are also coming to rely on the pharmacy, recommending them as an option for patients who face long waits for office visits or scheduling conflicts.
Multiplying the impact of the pharmacy POC, pharmacies provide multiple touchpoints for patient education. From in-store kiosks and print materials to face-to-face consultations, patients can access information in ways that suit their preferences and needs. Going in for a flu shot can also mean becoming aware of a new vaccine, conditions, or even over the counter complimentary treatments to help with side effects or illness. This multi-faceted approach to education and care helps address health literacy gaps, streamlines preventative and regular healthcare, and reinforces the importance of medication adherence.
"We continuously keep our pharmacy up to date on any CDC guidelines and new vaccines. By keeping our pharmacists up to date on the ever changing world of vaccines, our patients can trust our pharmacist to make strong recommendations on all the latest guidelines. Whether it's COVID, RSV flu, our pharmacists are up to date we also work with our marketing department to get the latest and newest vaccines visible and our marketing tactics can provide our teams with patient friendly resources to share with all of our patients."
A critical platform for educating patient behavior and driving outcomes, the pharmacy POC is a frontline for patient education.
The Power of Presence in Pharmacy Innovation
Outreach and effectiveness unique to pharmacy include community support programs, which can be exponentially made more effective with apps, mailings, and digital and in-person communication programs. Expanding their reach and service, some pharmacies are going further to expand points of care. Giant is working on in-home immunization services for immobile or restricted patients. Community-based programs that tap into local events and community centers are creating new health awareness and activating previously unengaged patients.
Novel forms of outreach by pharmacy groups is growing the recognition of pharmacies as go-to resources for public health initiatives. In “Empowering Communities,” Su Jin Roberge, Clinical Program Manager at Giant Food, shares how Giant’s mobile pharmacy services and collaborations have driven access. In addition to new inroads with local organizations like faith-based centers and schools, their public efforts have become a beacon for local agencies. For the new respiratory syncytial virus (RSV) vaccine, local government reached out to ask for help, to get constituents vaccinated due to an old regulation that was blocking this important preventative care. Ro Barish shared that the renowned came with an increased perspective on the reach of pharmacies, saying, “It was very humbling for a body of governance to reach out and say, ‘You guys are the experts at giving vaccines tell us how we can help you get there.’”
The collaboration between Giant Food and government agencies is a powerful demonstration of how innovative care delivery can overcome regulatory barriers and improve accessibility for a larger community. In parallel, there is untapped potential for marketers and brands to partner with pharmacies for localized and networked initiatives. Go where the pharmacy goes and mobilize the reach and trust they’re working hard on expanding.
Final Talking Points
It is not enough to have the right treatments, if the right patients are not able to both access and sustain treatments. As raised in these first episodes of The Science of Medication Access: Is It Working?, we need to be more vigilant around what access really means, how we can drive adherence, and how to surround patients with effective interventions across points of care.
Medication nonadherence is a complex issue that requires a multifaceted approach. As healthcare stakeholders, we have to vigilantly:
- Prioritize patient education throughout the medication journey
- Leverage the unique position of pharmacists and other point of care practitioners
- Develop patient-centric strategies and materials
- Foster collaboration across the healthcare industry
The journey to better medication adherence is ongoing, but with the insights like those found in the ConnectiveRx podcast and strategies from our larger community of experts, we’re better equipped to make a real difference in patients’ lives. Together, we can work towards a future where patients are empowered by the medications they need and able to fully benefit from their prescribed treatments.
Ready to dive deeper?
Listen to the full episodes and stay tuned for more expert insights on ConnectiveRx’s podcast series.
