In a perfect world, all patients would adhere to their treatment regimens.
But the world is far from perfect.
Definitions1
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. “Adherence” evokes more the idea of cooperation between the prescriber and his patient and less the connotation of the patient’s passive obedience to the physician’s instructions.
Adherence related sciences represent a complex and rich field because of the fact that it operates across the boundaries between many disciplines: medicine, pharmacy, nursing, behavioral science, sociology, health economics, IT&C, service design, communication, etc1. We will focus on adherence to treatment regimens.
Adherence is a process composed of initiation, implementation and discontinuation. Initiation occurs when the patient takes the first dose of a prescribed medication. Implementation is the extent to which a patient’s actual dosing corresponds to the prescribed dosing regimen, from initiation until the last dose. Finally, discontinuation occurs when the patient stops taking the prescribed medication, for whatever reason(s). As a consequence, non adherence happens in the following situations or combinations thereof: late or non-initiation of the prescribed treatment, sub-optimal implementation of the dosing regimen or early discontinuation of the treatment, known as non-persistence1.
Adherence is an issue for virtually all treatment regimens and all disease conditions. It affects all social classes and cultures. Non-adherence to medication is reported in all geographies, no matter the level of economic development.
Average rates to different treatment regimens2
Average adherence rates of 10 selected disease conditions2
Average adherence rates to hypertensive medication in 5 European regions/countries3
Austria: 66%
Wales: 62%
England: 59%
Poland: 42%
Hungary: 30%
Improving adherence will likely help create a win-win scenario among patients, professionals, payers and pharmaceutical companies.
Poor adherence to medication accounts for substantial worsening of disease, death and increased health care costs4.
It has serious negative consequences for patients, providers, sick funds, employers, pharma industry and society5.
Many studies demonstrated that poor adherence with a therapeutic regimen have a major impact on clinical outcomes and, as a consequence, on patients’ quality of life.
The impact of non adherence on costs
The impact of non adherence to medication on health-care resource utilization (HCRU) and therefore costs are likely to work in two ways:
– The immediate and direct impact of poor compliance on medication acquisition costs. Adherence will increase these costs.
– The less immediate and indirect impact of poor adherence on subsequent overall HCRU associated with the condition being treated, as a result of affecting clinical effectiveness, and thus health outcomes.
Non-adherence is likely to reduce medicine acquisition costs but increase subsequent overall HCRU. For people who continue to obtain prescriptions but stockpiling their medicines, the impact is keeping the same level of acquisition and increasing the indirect costs10.
Improved adherence to medication produces substantial medical savings11
Roebuck et al. studied the relationship between medication adherence and the use and cost of health services in patients who had one or more of the following four chronic vascular conditions: congestive heart failure, hypertension, diabetes, and dyslipidemia.
This study shows that adherent patients spent significantly less than nonadherent patients, after combining the increase due to Rx pharmacy refills (in green on the graph) with the medical costs due to hospitalizations or emergency department visits (in purple on the graph).
Impact Of Medication Adherence In Chronic Vascular Disease On US Health Services Spending
(costs adherent vs. non adherent patients)
