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Clinicians often poor at predicting medication adherence


By Melanie Evans
Posted: May 21, 2013 - 7:45 pm ET
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Patients do not always take prescriptions as instructed and doctors cannot always tell who has lapsed, with potentially harmful and costly consequences. But that could change with more training, better tracking and less reliance by clinicians on rules of thumb for quick decisions, wrote three researchers in the Journal of the American Medical Association.

Those decision shortcuts can speed treatment, but not always effectively, said Zachary Marcum, a pharmacist and one of the report's three authors. Research suggests that clinicians often fail to accurately predict how closely patients stick to their prescriptions.

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It's critical that physicians get better at this—for better clinical outcomes and for providers and policymakers to get a handle on healthcare spending. Patients' willingness or ability to stick to prescription regimens could reduce Medicare spending on medical services by 0.5% for every 1% increase in prescriptions that seniors take to the pharmacy and fill, the Congressional Budget Office said last November.

“Changes in the use of prescription drugs have the potential to affect the use of medical services,” the CBO said. “For example, overuse or inappropriate use of prescription drugs may raise the risk of adverse reactions, triggering a need for medical treatment. But most often, pharmaceuticals have the effect of improving or maintaining an individual's health.” That could be by preventing complications or hospitalizations, for example, among diabetics and heart disease patients.

Marcum, an assistant professor of medicine at the University of Pittsburgh, and co-authors Mary Ann Sevick and Dr. Steven Handler, who both teach at the university, wrote that more thorough screening is needed to address the complexity of behaviors that prompt patients to take pills less often than necessary or not at all.

“It takes a long time and a lot of follow-up to address medication adherence issues when they arise,” Marcum said.

“We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition,” they wrote.

Patients broadly do not take medications for multiple reasons, including cost, inattention or perception that the drug does not work. Clinicians may also face patients with “inaccurate, irrational or conflicting normative beliefs about medications,” the authors wrote.

Electronic health records that capture information on medication adherence would give clinicians useful information and help when benchmarking quality, the authors said.

The 2010 health reform law includes new incentives for Medicare managed-care plans to seek greater medication adherence, they wrote. Bonuses for Medicare managed-care plans are tied to the percentage of enrollees who frequently fill prescriptions. “This is something that people will obviously be paying more attention to,” Marcum said.

Sevick is an associate professor of medicine, behavioral and community health, and clinical and translational science at the university. Handler is an assistant professor of biomedical informatics, geriatric medicine, and clinical and translational research, and director of clinical informatics at the university's biomedical informatics department.

Follow Melanie Evans on Twitter: @MHmevans


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