Treatment adherence can be the difference between success or failure for many initiatives within the healthcare and pharma community. Unfortunately, it is estimated that adherence for chronic conditions is only achieved 50% of the time. Obviously, that number should be keeping us up at night. But how can we collectively combat treatment and medication nonadherence to drive better outcomes? We need a deeper understanding of the patient as a person, by enhancing real-world data (RWD) with people-based intelligence and other social determinants of health (SDoH) factors. Before crafting a game plan, everyone must understand the issue and drivers behind the scenes.
What is treatment adherence?
Medical treatment adherence, also referred to as patient adherence or medication adherence, refers to how well a patient follows a prescribed plan recommended by their healthcare provider. Adherence can indicate taking medication as prescribed, following specific diet and exercise guidelines, attending appointments, making lifestyle changes, and much more.
Being adherent means following these instructions and guidelines both consistently and correctly. Adherence to a treatment plan involves embracing all aspects to gain the full benefits and have the best possible outcome.
Why don’t patients adhere to their treatment plans?
Numerous factors can contribute to the challenges individuals face in adhering to treatment. These may include forgetfulness, struggles in managing medication schedules, financial limitations, the presence of side effects, or even a lack of awareness regarding the consequences of non-adherence.
“Nonadherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations each year in the United States.” Source
Manifesting in many ways, non-compliance to medication can be skipping or altering doses or taking no medication at all. It also includes taking doses at irregular intervals or missing them entirely and “making up” a dose by doubling the next dose taken.
Even after knowing that medication nonadherence negatively impacts treatment effectiveness, the statistics overwhelmingly show that those impacts are either not a determining factor for patients or that there are other factors at play. Simply said, even if a patient understands that a lack of adherence will give them a worse outcome, they will continue to make the same choice.
Some patients are resisting adhering to their treatment plan consciously. Meanwhile, other patients may act as bystanders when it comes to their healthcare, resulting in the same low level of adherence. Understanding the mindset of different patient populations, specifically how adherence is affected by both actions and attitudes is critically important and has been a major area of study for the Cognitive Sciences team at AnalyticsIQ.
When faced with the many possible contributing factors, how can we work with patients to either navigate around their barriers to adherence or better educate them on the impact on their health? First, we must understand the potential drivers to patients breaking from their treatment plans.
Reasons for medication noncompliance
Lack of understanding
Education and health literacy
Limited access to health education or health literacy presents challenges for individuals trying to decipher medical instructions.
Not fully understanding the benefits of adherence and underestimating the significance of following treatment plans as the doctor prescribed.
Medication nonadherence can involve failing to communicate openly with healthcare providers about challenges, concerns, and difficulties with treatments. This lack of dialogue hinders the healthcare team’s ability to support their patients.
Lack of insurance coverage
Many Americans continue living without insurance coverage, meaning all costs associated with the treatment plan will come from their personal budget. For many populations, it means they must choose between other necessities and the prescribed medication.
High out-of-pocket costs
Even those with coverage may have high out-of-pocket costs, especially for high-cost medications or treatments. If a treatment can affect a patient’s ability to work due to fatigue or additional side effects, they may choose to skip it to avoid missing shifts.
Lack of Access
Difficulties accessing care or tests at the beginning of a treatment plan or at meaningful intervals can be a major barrier for many patients. That may be a financial constraint if they cannot afford a vehicle or rideshare. It may also be due to physical limitations if leaving home alone is too challenging based on eyesight or mobility issues.
Access to services
Distance to healthcare facilities or lack of providers in certain geographic areas are barriers for those in need. In addition, long waiting times to see a provider or specialist for those groups make medication nonadherence less of a choice and more a result of a simple lack of access to necessary care and follow-up.
Social and Cultural Influences
Cultural and language barriers
Religious and political beliefs, language barriers, and communication difficulties can all impact adherence. For example, medication nonadherence is more likely if instructions are not provided in a language the patient understands or if cultural beliefs conflict with treatment methodologies.
Stigma and social isolation
Some medical conditions historically have had stigmas attached to them. This leads to emotional effects like feeling shame or embarrassment. Individuals may avoid seeking treatment or disclosing their condition, leading to isolation by hiding symptoms from potentially supportive resources like friends and family. It can also be that when shared, they can be pressured not to take it, to go off plan, or seek alternative treatments.
At first glance, side effects do not fall into the same category as the above. However, side effects significantly influence a patient’s medication compliance.
When an individual experiences physical discomfort due to medication side effects, they may assume that the treatment is ineffective or that it is simply “not worth it”. Fear of long-term side effects leads to anxiety over procedures or other interventions as part of a treatment plan. This can lead them to modify or discontinue treatment altogether.
The impact of medication nonadherence
Nonadherence not only affects patients. It also has significant consequences for healthcare systems, insurance providers, and pharmaceutical companies. Dealing with medication nonadherence is crucial for everyone involved.
Cost of medication nonadherence for healthcare systems and insurance providers
The effectiveness of treatment is compromised when individuals don’t take medicine for their condition as prescribed, follow lifestyle recommendations, or attend necessary appointments. Conditions progress or do not improve as expected, resulting in prolonged illness, and increased complications. Patients who don’t manage chronic conditions, such as diabetes, hypertension, or asthma properly are more likely to experience exacerbations or preventable adverse events when not practicing adherence.
“Approximately $100 to $300 billion in healthcare costs could be curtailed annually by addressing medication adherence.”1
In value-based care and reimbursement models, it is even more complicated. Tying patient outcomes to reimbursement impacts the financial performance of healthcare systems. If medication nonadherence contributes to poor patient outcomes or increased healthcare costs, it can affect the achievement of quality metrics and result in reduced reimbursements from payers.
Unnecessary healthcare utilization contributes to overburdened resources.
Individuals who fail to follow their treatment plans may seek additional medical care or interventions when symptoms are uncontrolled or worsening. This strains healthcare resources and increases the workload on healthcare providers. Miscommunications can also potentially occur if multiple providers are sought for additional perceived treatment needs.
Those noncompliant with medication and treatment plans may also require more frequent medical attention. This puts a strain on healthcare facilities, providers, and support services. It leads to longer wait times, reduced availability of appointments, and compromised quality of care. The result is an overburdened system that contributes to poorer outcomes and increased healthcare costs across the board, not just for those not adhering.
Uncontrolled conditions lead to higher volumes of high-cost situations.
Medication nonadherence can increase the cost burden of:
- Specialty outpatient visits
- Diagnostic testing
- Preventable procedures
- Additional medications
- Hospital stays
- Emergency services
Impact of poor medication adherence to pharmaceutical brands
Damaged prescriber reputation
The burden of compliance has historically fallen solely on the patient or caregiver. Without knowing the level of medication adherence, physicians and other HCPs do not know if continued or worsening symptoms are due to a lack of the treatment’s effectiveness or poor adherence. In turn, a prescriber may assume your treatment is ineffective for a similar patient and may not prescribe your medication again.
The ultimate impact of medication nonadherence on pharmaceutical companies is straightforward. If a prescribed treatment plan includes a daily pill, which is taken every other day, the revenue for that patient is negatively impacted by half. While that may seem unsympathetic to patients facing declining health, it is a quantitative figure pharma teams can use to support the budget for adherence-focused initiatives.
How to improve medication adherence
Improving adherence can contribute to better outcomes, boosted revenue, and optimized resources. Essentially – everyone wins!
Identify the barriers to medication adherence faced by the patient or patient population.
Every patient and community is different, so the first step to developing a plan of attack is correctly identifying the possible reason for nonadherence. It can be done after asking the patient what keeps them from sticking to the plan. It can also be done in advance and at scale by applying people-based data intelligence and , social determinants of health (SDOH) data to your patient populations and real-world data (RWD).
A complete SDOH dataset should include the following elements:
- Access to Care & Health Barriers
- Access to Technology
- Core Demographics
- Economic Insecurity
- Food Insecurity
- Geography (e.g., urban vs. rural)
- Housing Insecurity
- Language Proficiency & Barriers
- Social Isolation
- Substance Abuse (including smoking)
- Transportation Barriers
Examine attitudes and actions toward healthcare
At AnalyticsIQ, we have conducted research beyond the standard SDOH variables to predict the likelihood of a person’s adherence. This research evaluated the cross-section of both attitudes and actions to create our Health and Wellness Personas:
- Wellness Strivers: The “by-the-book” health fanatics
- Care Plan Conformists: Dependable but unenthusiastic
- Conscious Resisters: Mindful and independent
- Well-being Bystanders: Hard-working non-planners
Addressing patient education
Once data has been applied, and analysis is complete, real-world evidence (RWE) can indicate whether patient education and understanding may be contributing factors.
Simple is better. Providers who use simple language and avoid jargon and complex terminology help in ensuring that patients understand the diagnosis, treatment options, and the rationale behind the recommended plan. Encouraging patients to ask questions and taking into account their perspectives and misconceptions to provide reassurance when necessary is a helpful next step.
Before educating your patient population, you may need to educate your HCPs and other providers on the best tactics to explain the complex subject matter. No two HCPs are the same, so understanding their motivations and communication preferences is a productive exercise.
Healthcare providers and pharmaceutical brands may develop educational materials demonstrating the benefits of adherence. These materials are made more effective by incorporating the patient’s diagnosis and treatment plans to maximize relevance.
Highlighting data and stories gathered from similar patients can further personalize the experience. It emphasizes the real potential in their personal healthcare experience. For this strategy, having actual data on adherence vs. nonadherence outcomes with real patients is helpful to gather and maintain.
Simplify treatments when possible
Similar to simplifying communication, simplifying medical treatment programs can take a less is more approach. Automatic refills and 90-day or 120-day prescriptions can lessen transportation barriers. Likewise, collaborating with other healthcare professionals like pharmacists or nutritionists can reduce duplicate testing or unnecessary appointments, thereby lessening costs. If adherence lags, a willingness to pivot treatments to less time-consuming or costly options is also important.
Monitor patient adherence
Electronic reminder systems through apps and automated systems take some of the mental load off the patient while managing their condition. These alerts can share information not just with the patient but also with their support system as well as their healthcare practitioner if the appropriate permissions are granted.
Even without the assistance of reminder systems, providers can request regular feedback between appointments. Understanding if a treatment is ineffective for their condition versus simply due to nonadherence is important medical data required to determine the next steps.
Addressing barriers from public health care cost or access
Prior authorization and insurance education
Most individuals do not budget for high co-pays and deductibles in advance. By communicating costs upfront, providers and patients can establish if cost is a barrier to adherence or if it’s manageable. Healthcare systems can also aid by streamlining the prior authorization process, which can be a barrier to accessing treatments and medications.
Assistance programs and cost management
Healthcare systems can help alleviate the financial burdens on patients and their resources by addressing financial costs. Patient assistance programs benefit both by identifying and informing patients about programs and payment plans that make continued care more attainable. These programs provide financial assistance, medication discounts, or free medication to eligible patients who cannot afford the full cost of their treatments when adherence is most needed.
Addressing cultural or social factors related to poor medication compliance
Involve patients in the decision-making process
When patients actively participate in decisions about their health, they tend to have a greater sense of ownership. Discussing the patient’s treatment along with expected outcomes provides the necessary context. It also gives patients the opportunity to discuss how a treatment plan may align with their personal beliefs or lifestyle, helping to address misconceptions or identify an alternate plan early on.
Apply cultural awareness to the treatment
Healthcare systems that develop cultural competence tend to tailor care and patient education accordingly. Adopting a patient-centered approach that frames treatment through the patient’s belief system makes their community support more likely. It may include providing materials in a patient’s native language or suggesting an alternate plan based on cultural restrictions. This is achievable at scale by applying people-based data intelligence with real-world data (RWD), makes adherence more likely, and reduces unnecessary resource use within the health system.
Monitor mental and emotional effects.
Unfortunately, providers only get a snapshot of the patient’s daily life during outpatient treatment. Long-term and chronic diseases take a toll on the patient’s emotions and mental health. Providers can take a collaborative goal-setting approach and praise adherence while not shaming medication nonadherence.
Encourage peer support and community engagement.
Experienced patients with success stories facilitate a sense of understanding which may encourage adherence. In the same way, support from others with similar challenges can provide a community that fosters motivation and accountability. Sponsored or partnered communities or support groups can contribute to a more welcoming environment to stick to a treatment plan.
Taking the next step
Tackling any strategic issue, particularly those involving complex health-related issues, starts with understanding. Selecting data that fills in the gaps in your patient population can be the difference between a successful program that shows an increase in adherence or missed opportunities. Taking a full view is required to create and roll out programming designed to knock down treatment plan barriers.
Need a partner to help you see your patients beyond the chart? AnalyticsIQ partners with healthcare organizations, insurance providers, and pharma companies every day to help them acquire the intelligence they need to move the needle. Our data powers research and initiatives that are driving better outcomes, health equity, and more.