Medication Adherence Is a Problem, but Not the Only Problem

Nonadherence to medications is a universal issue that has garnered significant attention in recent years. It has been linked to poor health outcomes, increased hospitalizations, and even death—all of which cost the US healthcare system billions of dollars.

However, a new study published in the Journal of Managed Care & Specialty Pharmacy concluded that medication nonadherence represents only a fraction of medication-related problems (MRPs) experienced by patients. The study, led by Todd D. Sorenson, PharmD, insists that healthcare needs to expand its narrow focus on adherence as a problem to MRPs. By focusing just on that will limit the ability to control morbidity and mortality associated with nonoptimal medication use.

The study attempts to review the focus of medication nonadherence in the literature by outlining a broader framework for MRPs, and identifying the rates of medication nonadherent through a comprehensive medication management (CMM) care model.

Triple Aim Not Solely Dependent on Medical Adherence

Medication adherence is one of the leading problems (third most frequent type of MRP) in better healthcare. Nonadherence could mean requiring a medication that has not been prescribed, or receiving a low-dosage prescription not enough to show results, or a patient discontinuing a medication because of adverse effects.

Success in achieving the triple aim of healthcare (improved health, better care experience, and reduced per capita costs) is highly dependent on optimizing medication use. However, the study insists on expanding the lens to study beyond medical non-adherence.

“Although medication adherence has been studied through many lenses, including specific disease states, patient populations, behavioral factors, and economic factors, what is lacking in the literature is a comprehensive analysis of the degree to which nonadherence is a problem in comparison to other types of problems associated with medication use,” noted Sorenson.

The researchers agree that poor outcomes or avoidable costs are deemed to be a result of nonadherence alone. But that is only a part of the problem.

Moving Beyond Medical Non-Adherence

To understand the scope of nonadherence when CMM services are used, the researchers studied the frequency of MRPs in patients within the Fairview Health System from January 1, 2013, through December 31, 2014, across 7 categories. The study found that 40% of patients had an MRP associated with medication nonadherence.

But more important was the finding that the remaining 60% experienced problems that were not related to medication adherence. The most common MRPs experienced by patients were “dose too low” and “needs additional drug therapy.”

If healthcare policy continues to emphasize solely on adherence as a marker of appropriate medication use, then it will not fully achieve the promise of the triple aim.

“The majority of MRPs are not related to adherence,” the study noted. “If left unresolved, they can obstruct achievement of desired health outcomes and cost savings associated with well-managed chronic illness.”