Medication Adherence Methods

Drug companies are very interested in the topic of medication adherence because it tends to increase their revenue.  Payers and providers are also concerned because often medications can improve outcomes and lower overall spending.  Much research is going into the causes of lack of adherence and what tactics may improve it.  Non-adherence may start with not even picking up a prescription or may be failure to take pills when and as prescribed.  A review article in the American Journal of Managed Care looks at various programs designed to encourage following of drug regimens.   (AJMC Article)

The studies reviewed focused on interventions in regard to cardiac medications.  The researchers winnowed through a large number of studies and found 51 that were relevant.  These studies included in-person, phone and other forms of intervention.  In general, there were many more studies that relied on a personal intervention than a non-person dependent one, such as an automated phone call or text message.  Among the person independent studies, it appears that electronic interventions are more likely to be successful than non-electronic ones.  Among person dependent ones, in-person interactions were more successful than remote ones, like a phone call.   Phone calls from a pharmacist were most likely to work, but the highest rate of success was in-person interventions from a pharmacist at the pharmacy.

One thing lacking in this review is a discussion of the connection of adherence to outcomes:  does encouraging patients to take their drugs lead to better health outcomes, and if so, is there additional spending, including the cost of the intervention, or is there a net cost-savings.  Some research indicates that patients who adhere to prescribed drugs do have better health outcomes and lower long-run spending but more work is needed to connect specific adherence interventions with those outcomes.   As the article suggests, there is also work to be done on what the best communication channel, deliverer of information and setting is for interventions, and the extent to which different populations or personality types may respond better to different interventions.