Improving adherence requires an active process of behavioral change, which is nearly always a challenge. 5Īlthough there are many potential barriers to appropriate adherence (Sidebar: Potential Barriers to Medication Adherence), I contend that a more realistic perspective is that in changing human behavior, inertia is the rule, and change the exception. This framework has the implicit assumption that adherence is the norm and that when it fails, there must be obstacles that are interfering with the process. Much of the earlier literature on medication nonadherence focuses on barriers to adherence. To the extent that incentives are available with pay-for-quality programs, the amounts involved are too small to motivate busy physicians. The fee-for-service model incentivizes services, not quality or improved outcomes. Fee-for-service medicine provides little incentive for individual physicians to address this. Yet when this fails, as it does 40% to 50% of the time, it is seen solely as a patient issue, rather than a system or clinician responsibility. In the pervasive traditional medical model, it is the responsibility of the physician to make an accurate diagnosis followed by an appropriate prescription, with at least some effort at educating and perhaps motivating the patient. To the extent that they do, they see it as the patient’s responsibility to correct this problem. Practicing physicians remain largely unaware of this problem. Insurers and health plans have other priorities, and few have addressed this problem in a systematic manner. 4 This topic does not fit into the boundaries of any one discipline. To my knowledge, no major entity, organization, or group has taken it on as a priority. It does not appear on the death certificate of a patient who has died of a myocardial infarction after not taking his antihypertensive medication or an antiplatelet agent to protect his stent. Yet, unlike better-known causes of death such as heart attack or cancer, medication nonadherence is usually invisible to patients, their families, and the medical profession. Disease-specific meta-analyses validate a significantly increased risk of death in nonadherent patients. Effective change will not happen until key players decide to take on this challenge and reimbursement systems are changed to reward health systems that improve medication adherence and chronic disease control.Īlthough deaths caused by nonadherence are hard to measure, the estimate of 125,000 deaths per year is widely cited in the literature. Using similar elements would be feasible in other health care systems but would require motivation and planning. In at least one integrated health care system, Kaiser Permanente Northern California, a combination of approaches centered on the electronic health record has improved medication adherence rates to above 80%. Improving medication adherence has not been well studied, but a Cochrane review shows that multifactorial interventions are more effective. It is not easy for humans to change their behavior, even for what many physicians see as a minor change such as taking prescription medications. This approach minimizes and oversimplifies the problem. Much of the literature on nonadherence focuses on barriers to adherence, with the assumption that appropriate adherence is the normal course of events and nonadherence is an aberration. Despite this, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |