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Adherence Challenges: Why In-Home Pharmacy Interventions Might Be the Best Medicine for Complex Patients


Kerri Musselman


November 02, 2022


Medication adherence, or lack thereof, plays a critical role in the health of aging populations. Taking medications as prescribed positively affects quality and length of life, health outcomes and overall healthcare costs. On the flip side, nonadherence is responsible for up to 50 percent of treatment failures and 25 percent of hospitalizations. In total, medication nonadherence is a $500 billion problem for health plans, providers, and consumers. The cost is not just financial. This issue also leads to 150,000 preventable deaths each year. 

Typically, adherence rates of 80 percent are needed to ensure optimal therapeutic efficacy, yet for medications related to chronic conditions, adherence rates start at 50 percent and decline from there as barriers emerge.

In some cases, a lack of adherence falls at the feet of patients. Patients will often stop taking the medication because they feel it isn’t working – a lack of immediate gratification. In other cases, it’s because symptoms aren’t visible. For instance, patients with high blood pressure can’t always physically notice their blood pressure is high. They may decide they don’t need the medication because they feel fine.

But the bigger part of the story are the systemic barriers that negatively affect adherence. Below, we address three of these barriers and their impact on outcomes.

1. Drugs are Expensive

In less than 10 years, prescription drug prices have ballooned by 35 percent, compared to a 19 percent increase across all items and services. A recent poll showed that 18 million Americans can’t afford to pay for their needed medications. Separate research estimated that one-third of Americans skip doses of their prescriptions due to cost.

Rising prescription drug costs continue to apply pressure to patients, as well as payers. This is a growing problem that adversely impacts adherence, and basic access as well.

2. Education is Not Available

Misinformation and/or a lack of understanding about prescribed medications present significant hurdles for patients. In many cases, patients haven’t been fully educated about why each medication has been prescribed, how to effectively take it and how to manage side effects, which can quickly derail adherence if patients aren’t prepared for them.

Much like primary care physicians who are handcuffed by a lack of sufficient time during office visits, retail pharmacists are also limited in the time they can spend educating patients. These professionals value being able to invest in education and setting patients up for success. Not having the time to properly educate and support patients is a contributing factor for the exodus of qualified pharmacists from the retail setting. As more pharmacists choose different career paths, the problem gets worse. The end result is that neither physicians nor pharmacists have the time and opportunity to fully educate patients on their medications.

3. No one has the full picture.

Patients who are managing chronic health issues are almost always on multiple prescriptions. They also typically are using several over the counter medications as well. No one has a full picture of all medications these complex patients are taking. As a result, these patients are at higher risk of polypharmacy issues, unnecessary complications and side effects. And more adherence issues. Also, it can be difficult to determine when SDOH needs are interfering with adherence to medications. Without a holistic view of the patient, providers are at a disadvantage as they try to care for these patients between visits and keep them from experiencing declines in their health.

How do we effectively improve adherence?

Obviously, we should be treating the patient as a whole person to ensure the right treatment is being delivered at the right time. We should be evaluating ALL their medications and delivering a coordinated response that ensures they are taking what they need and that their regimen is effective and appropriate. And that they can comply with prescribed medications, because we have addressed both education and SDOH needs.

One effective way of positively impacting adherence and helping minimize polypharmacy issues is to bring pharmacist support into the patient’s home. When this support is part of a home-based visit, the pharmacist can address SDOH needs while also gaining a full view of all medications the patient is taking, both prescription and over the counter. In home visits can effectively streamline medication regimens, while also comprehensively identifying and addressing barriers to adherence.

Progressive health plans are sponsoring the deployment of multi-disciplinary, field-based teams that serve as an extension of provider practices by bringing care into the homes of vulnerable and underserved populations. These care teams typically include a pharmacist to help evaluate medication regimens while problem solving for adherence issues.

Today’s reality is that medications are extremely expensive. Patients juggling multiple medications aren’t receiving enough guidance and support from traditional healthcare venues. No one has the full picture of all medications a patient has purchased or been prescribed. No one fully understands why a specific patient is not fully complying with prescribed medications. And no one has comprehensively educated the patient on the medications that have been prescribed. This reality impacts adherence, overall quality of care, and ultimately clinical and financial outcomes.  Sending a pharmacist into the home as part of a multidisciplinary care team is a winning prescription for vulnerable and underserved patients. It is a proven path to improved adherence and an approach worth serious consideration for health plans who want to enhance both quality and cost outcomes associated with their pharmacy spend.

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