There is no universal solution for improving adherence. It has to be addressed on a patient-by-patient basis, Coleman adds.
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In many cases, physicians know that patients are non-adherent and even why, but don’t have the time or resources to address it, says the ACP’s Nickel. “Doctors are being pulled in so many directions. The problem is time. Who has time to provide all this information” to patients, she asks.
Some practices are adding care managers and other staff who can address non-adherence as part of their care coordination efforts. Others are using technology, such as secure messaging, texting and at-home medical monitoring, prompting and communication tools to improve adherence.
For Oak Street Health, a multi-site practice with clinics in Illinois, Indiana and Michigan, having current data and patient updates are key to improving adherence, says primary care physician Laolu Fayanju, MD. The organization receives reports from the Centers for Medicare & Medicaid Services (CMS) and commercial payers that show medication adherence (from claims on filled prescriptions), clinic by clinic and patient by patient. This allows doctors to identify and address problems.
Oak Street Health uses registered nurses, nurse practitioners and social workers to follow up with patients following appointments to ensure adherence. Staff members who visit a patient’s home might even count pills to see if the patient is really sticking to the regimen and prepare for problems resulting from non-adherence, Fayanju says.
“My team and I are not flying blind,” he says. “We have the relevant information on our patients.”
Physicians aren’t alone in tackling patient non-adherence. CMS, commercial payers, employers, pharmaceutical companies and medical technology firms have undertaken their own initiatives to improve adherence to make medicine more effective, cut costs and, in the case of pharmaceutical companies, increase revenues.
Some pharma companies are developing “smart pills” embedded with sensors that can send an alert when a pill is swallowed or when a dose is missed. Others are awarding gift cards to patients who refill prescriptions. And the industry has lobbied regulators for permission to pay third parties, such as pharmacists, to remind patients to take their medications. Also, manufacturers are creating medical devices, such as inhalers, that can record the time and date of their use.
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In addition, some employers are rewarding employees for taking part in wellness programs that can reinforce their physicians’ orders to lose weight, exercise more, stop smoking etc. And commercial insurers are experimenting with giving free medications and providing financial incentives for patients who stick to their treatment plans. Private payers also give information regarding non-adherence to doctors.