Medication adherence: A call for action

doi:10.1016/j.ahj.2011.06.007

American Heart Journal

Volume 162, Issue 3, September 2011, Pages 412-424

https://doi.org/10.1016/j.ahj.2011.06.007 Get rights and content

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.

Section snippets

Definition and measurement

Medication adherence refers to the extent to which patients follow provider recommendations about day-to-day treatment with respect to the timing, dosage, and frequency.²⁶ It may be defined as “the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen.”²⁶ Medication persistence refers to the duration of medication-taking and is defined as “the duration of time from initiation to discontinuation of therapy.”²⁶ The World Health Organization

Review of medication adherence interventions and programs

Interventions to improve adherence with prescribed medications are more successful for short-term treatments than for long-term, chronic illness management²⁷ For long-term treatments, 36 of 83 interventions reported in 70 randomized clinical trials (RCTs) were associated with improvements in adherence; but only 25 interventions led to improvement in at least one treatment outcome (Table II). Almost all of the interventions that were effective for long-term care were complex, including

Practical, evidence-based strategies for clinical practice

We set out to identify practical strategies to address the complex problem of medication adherence in clinical settings. Our assumptions included the following basic beliefs: (1) that proven strategies should be considered and integrated in a tailored, multipronged fashion for each case; (2) that medication adherence is a shared goal for which all members of the health care team, the patient, family, providers, community liaisons, and health policy makers, have an inherent role and

Financial incentives and medication adherence

For many patients on Medicare, the coverage gap in Part D is a financial challenge, particularly for inexpensive medications. Sometimes, generic alternatives provided at low cost by national chains like WalMart or Kmart can provide a solution. A number of studies have examined the importance of copayments on medication adherence. Numerous studies have shown a strong and consistent relationship between copayments and medication adherence.⁷⁹ This has led to a movement, known as Value Based

Future directions and recommendations

There are both enormous challenges and opportunities in addressing the public health crisis of medication adherence. The multifactorial basis for nonadherence calls for a multifaceted solution. The first important theme in this think-tank meeting was that a large number of interventions could, if effectively applied, have a large impact on adherence and thereby on improving public health. An initial step is a common understanding of some of the key issues among stakeholders including

Conclusion

In summary, if >100 different factors have been identified as potential predictors of medication adherence, one cannot expect “one size intervention, to fit all.” We need to examine alternative methods of implementing interventions to create an effective, readily available, and easy to use tool box for providers. Technology will increase in use and will likely help many individuals, but development of technology needs continued input from both patients and providers on how to incorporate these

Acknowledgements

This research is supported by a VA HSRD career scientist award (RCS 08-027) and an Established Investigator Award from the American Heart Association to the first author (H. B. B.). Dr. B. Granger was supported by A NIH funded CTSA grant (UL1RR024128). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

We would also like to acknowledge the participation of the following individuals:

Anders Bergbrant,

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Results of Expert MeetingMedication adherence: A call for action

Section snippets

Definition and measurement

Review of medication adherence interventions and programs

Practical, evidence-based strategies for clinical practice

Financial incentives and medication adherence

Future directions and recommendations

Conclusion

Acknowledgements

Value Health

Value Health

Am Heart J

Am Heart J

Soc Sci Med

Am J Med

Clin Ther

J Card Fail

Patient Educ Couns

Lancet

Am J Hypertens

Geriatr Nurs

Am Heart J

Adherence to medication

N Engl J Med

Long-term persistence in use of statin therapy in elderly patients

JAMA

Persistence of use of lipid-lowering medications: a cross-national study

JAMA

Adherence to pharmacologic management of hypertension

Can J Public Health

Benefits of adherence to antihypertensive drug therapy

Eur Soc Cardiol

Compliance, electronic monitoring and antihypertensive drugs

J Hypertens Suppl

Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications

Lancet

The price you pay for the drug not taken

Business Health

Statin adherence and risk of accidents: a cautionary tale

Circulation

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

N Engl J Med

Medication compliance: a healthcare problem

Ann Pharmacother

Developing compliance instructions for drug labeling

Clin Pharmacol Ther

Hospital admissions resulting from preventable adverse drug reactions

Ann Pharmacother

Practical approach to determining costs and frequency of adverse drug events in a health care network

Am J Health Syst Pharm

Adherence to long-term therapies: evidence for action. Geneva

Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research

Circulation

Patient adherence and medical treatment outcomes: a meta-analysis

Med Care

Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry

Circulation

Family influences on heart failure self-care and outcomes

J Cardiovasc Nurs

Effects of guided care on family caregivers

Gerontologist

Interventions for enhancing medication adherence

Cochrane Database Syst Rev

Interventions to enhance medication adherence in chronic medical conditions: a systematic review

Arch Intern Med

The implications of therapeutic complexity on adherence to cardiovascular medications

Arch Intern Med

A pharmacoepidemiologic analysis of the impact of calendar packaging on adherence to self-administered medications for long-term use

Clin Ther

Crossing the quality chasm: a new health system for the 21st centry

A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045

Implement Sci

Results of Expert Meeting
Medication adherence: A call for action