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What causes half of all chronic disease treatment failures?

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When patients who have suffered a heart attack or are diagnosed with a cardiovascular condition take related medication as prescribed by their doctor’s treatment plan, they can reduce the chance of experiencing future complications, according to a study recently published in the Journal of the American College of Cardiology.

Why wouldn’t someone take medicine according to their doctor’s instructions? Apparently there are a lot of reasons, notes Jay RajdaAetna’s chief clinical transformation officer and one of the researchers of the study. So-called non-adherence can be due to a person not knowing enough about their condition or forgetting to take the drug because they are already taking a number of other prescription medications.

Regardless of the cause, non-adherence is a serious issue. The U.S. Centers for Disease Control and Prevention reported that 30 to 50 percent of chronic disease treatment failures and 125,000 deaths per year can be attributed to people not taking their medication the way it was prescribed. The American Heart Association also found poor adherence to heart failure drugs is associated with an “increased number of cardiovascular-related emergency department visits.”

Failure to follow the drug regimen recommended by a health professional results in approximately 125,000 preventable deaths a year.

— U.S. Centers for Disease Control and Prevention

The Journal of the American College of Cardiology study was a collaboration between Aetna; Ferrer, an international pharmaceutical company located in Barcelona, Spain; and the Icahn School of Medicine at Mount Sinai in New York. Researchers looked at the percentage of heart attack patients, as well as those diagnosed with atherosclerotic disease, who were taking their medications as prescribed to treat their conditions. Atherosclerotic disease consists of plaque buildup in the body’s arteries. The medication adherence among these types of patients is generally low, according to Rajda.

Within two years of a cardiovascular event, at least 50 percent of patients are not adequately taking prescribed medications.

There were 4,015 heart attack patients and 12,976 patients diagnosed with atherosclerotic disease included in the study. Researchers divided the patients into three groups, depending on their medication adherence.

The researchers focused on studying medication adherence because up until now there was very limited evidence that showed the correlation between the level of medication adherence and the risk of future complications among similar cardiovascular patients.

“What we wanted to evaluate was the impact of adherence to medications on cardiovascular disease and cardiovascular outcomes,” Rajda said. “We found the patients who were fully adherent had substantially and significantly better outcomes than people who were partially compliant or non-compliant with their doctor’s instructions. The patients who stayed on course with their prescription also had lower overall health care costs.”

Why some patients may not take medication

Medication adherence, Rajda said, is a complex topic. There are a variety of reasons and factors that may contribute to patients not taking the medication prescribed to them by a health care professional. “One reason may be that people don’t fully understand what can happen if they don’t take the medicine as it is prescribed. They may take the wrong dose, stop too soon or may not take it at all, which sets up its own set of problems.”

People may lack motivation because they don’t understand the true value of taking the medication and the consequences of non-compliance. Sometimes they may be overly concerned about side effects. To help remedy these issues, Rajda said he believes education can help.

“Education would drive up the engagement of patients and could help them feel more comfortable and motivated to take their medications, but sometimes there are other reasons,” Rajda added. “Occasionally, some patients have several different medications to take at different times of the day and at different doses. This could be confusing and overwhelming to some patients. Daily medication organizers (like pill boxes) and reminder systems could be helpful to such individuals. Combination pills, which contain more than one medication in a single pill, might also make it easier and more convenient for patients to take all of their medications as prescribed.”

Sometimes cost is a factor. Lowering insurance copayments can help some patients afford the drugs, but it doesn’t always solve the overall problem for everyone. In the past, Aetna worked with Brigham and Women’s Hospital and Harvard Medical School to give free heart drugs to patients who had suffered heart attacks. The research found that when the cost factor was removed, it raised drug adherence from 42 percent to 49 percent in the study group.

Medication adherence lowers costs, improves health

In the more recent heart study, Rajda said researchers found there was a 25 percent reduction in the risk of a major cardiovascular event among patients that were fully adherent to their medication plan.

A higher medication adherence among patients can result in fewer hospitalizations and re-admissions.

The study also highlights the financial benefits of staying adherent. Researchers found cost differences between the adherence groups in both types of patients studied. For example, heart attack patients who were fully adherent were associated with reduced per patient administrative costs for hospitalizations. Why? A higher medication adherence among patients can result in fewer hospitalizations and re-admissions.

Tips to follow your treatment plan

New health care models like accountable care organizations and patient-centered homes are incorporating medical adherence into their health management strategies. Consumers can also get some help from an initiative by the National Consumers League called the Script Your Future campaign. The effort aims to help people understand their conditions so they understand the connection to medication adherence. The campaign gives people the opportunity to sign up to receive text reminders to take their medication, print out a wallet card to keep track of dosages and scheduling or create a medicine list for the home. In addition, some providers have designed and implemented individual counseling, medication education, pharmacy post-discharge programs, or visiting nurse or nurse practitioner-based services.

The U.S. Food and Drug Administration recommends taking long-term medication at the same time every day to make it a part of daily routine.  Pill containers and personal calendar reminders can help keep track of notes and when to take the medication. For more tips, visit the FDA.

Editor’s note:  At Aetna, Rajda said, there are incentives and programs focusing on medication adherence. The insurance company provides support to those who need high-cost specialty drugs to treat serious conditions. For example, the Aetna Healthy Actions RxSavings program is a value-based prescription plan to help members reduce out-of-pocket costs for select medications patients need to manage chronic conditions. Medicare Advantage patients can also receive an automatic phone call for refill reminders and receive pharmacist outreach focused on medication adherence.