OTN Specialty Services Focuses on Medication Adherence
OTN Specialty Services has developed and implemented a therapy management program focused on an interactive partnership with patients to promote medication adherence. A patient’s ability to follow their treatment plan may be compromised by several barriers, including socioeconomic factors, healthcare team, characteristics of the disease, disease therapies and patient-related factors. Interventions such as OTN Specialty Services’ MAPPSM program targets medication adherence tailored to the particular illness-related demands experienced by the patient.

Medication Non-adherence: Making a Significant Impact on Patients’ Health and the Nation’s Economy

By: Julie Zeplin-Nelson, RN, BSN.
Clinical Education Coordinator, OTN Specialty Services

“I just forgot!” “I hate taking drugs!” “These drugs are too expensive!” “I don’t think this medication is working!”

Unfortunately, these expressions reveal a patient’s non-adherence to medications, which has become a public health epidemic. In fact, the World Health Organization (WHO) has estimated that non-adherence to long-term therapy for chronic illnesses averages about 50%, with an even greater percentage in low-income groups.

Medication adherence may be defined as the extent a patient takes a medication in accordance to treatment dosage and schedule. Medication adherence is influenced by several factors. The patient’s ability to follow treatment plans is frequently compromised by more than one barrier, including social and economical factors, the healthcare team involved, and characteristics of the disease, disease therapies and patient related factors. Non-adherent patients tend to have a poor understanding of their disease and treatment. If adherence to therapies is to be improved it is essential that problems related to the above factors be addressed and solved.

“The direct and indirect costs of non-adherence totals approximately $100 billion per year in the United States.”

“Approximately 125,000 deaths annually are attributed to non-adherence, this is twice the number killed each year in automobile accidents.”

Adherence to a medication regimen is a critical component of living successfully with a chronic condition. Being adherent means taking an active role in your daily treatment and in the decisions that affect your health.

Non-adherence can have serious detrimental effects. Most patients who fail to follow their medication regime do not simply forget; they are frequently choosing to disregard their physician’s instructions.

Common non-adherent practices include:

• Not having prescriptions filled or refilled
• Altering prescribed doses
• Erratic dosing due to forgetfulness
• Discontinuing medication too soon

Some socioeconomic reasons include:

• Cost/ No insurance/ High co-pays
• Influence of friends & relatives
• Feeling better
• Fear of adverse reactions / side effects
• Fear of becoming dependent on medication
• No perceived benefit
• Dislikes taking medication
• Perception that more medication is better
• Complicated drug packaging
• Conventional medication reconstitution
• Lack of understanding the disease and its treatment
• Differing interests or expectations of the patients and healthcare provider
• Dissatisfaction with the healthcare provider relationship
• Poor health literacy

The implications of non-adherence are vast. The most obvious is interference with the therapeutic efforts of the healthcare provider, costly emergency room visits, unnecessary tests and/or diagnostic procedures, relapses, acute exacerbation of chronic illnesses, extended recovery times and even death. Consequences of poor adherence to long-term therapies add up to poor health outcomes and increased health care costs!

Pharmacist consultation has shown to be significantly effective in reducing patient non-adherence. Pharmacist led counseling programs are found to be effective because they provide an opportunity for a one-on-one relationship between the pharmacist and patient, which ultimately improves their knowledge and gets answers to their questions. However, research reveals that relatively few patients receive the full benefit due to the high volume of revenue driven prescription dispensing, pharmacist training and professional attitude. In addition, pharmacy-counseling levels are largely determined by the state regulations, in turn determining the intensity of patient consultation.

Another major reason for improper medication use and treatment failure for many Americans is poor health literacy. The Institute of Medicine (IOM) recently estimated that nearly half of all adults in America have difficulty reading, understanding and using health information. Therefore, health-related materials such as drug information sheets, medication labels and educational hand-outs a pharmacy provides patients most likely cannot be understood by many of the people for whom they are intended, thus lowering the adherence rate.

Given the striking magnitude of non-adherence and the need for effective solutions, many specialty pharmacies are increasingly enrolling in disease and/or therapy management programs. These particular programs focus on the clinical staff’s (i.e. pharmacist or nurse) role in implementing effective patient adherence programs to improve the quality of patient care and to reduce healthcare costs. Specialty pharmacy healthcare providers are moving toward a sharing, caring and more interactive partnership with their patients.

Until recently, most specialty pharmacies offered programs intended to manage drug treatment only. As the percentage of medication non-adherence rises, the payer demand for disease and therapy management programs also continues to escalate.

OTN Specialty Services, a leader in specialty pharmacy services since 1991, currently has a therapy management program in place to promote medication adherence, called ‘MAPPSM’. This particular program’s primary focus is first on our pharmacists/nurses developing a trusting relationship with each patient, as well as, utilizing a comprehensive approach to enhance communication skills and assessments that will enable our clinicians to effectively assess patients’ medication use, resolve drug therapy problems and promote positive behavioral changes.

OTN Specialty Services’ therapy management program is specifically for patients undergoing treatment for chronic diseases such as multiple sclerosis, rheumatoid arthritis, hepatitis C, irritable bowel disease and for the treatment of infertility. The goals of this therapy management program are to ensure prompt timing of the initial injection and uninterrupted therapy, improving quality of care, reducing medical costs associated with poor treatment adherence and promoting collaborative patient care with the physicians.

This program not only improves the patient’s quality of life, but maximizes the benefits of the medication dispensed; improving cost effectiveness of their drug therapy.

Medication Adherence is a dynamic process that needs continuous attention. Patient education and knowledge are critical factors in successfully treating and managing chronic diseases. ‘MAPPSM’ enables patients to play an active role in managing their disease and improving their health and quality of life!

“Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvements in specific medical treatments.”