1 Addressing the Problem of Medication Non-Adherence Patti Higginbotham, AOCN, APRN Kris Admire, BA.
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Transcript of 1 Addressing the Problem of Medication Non-Adherence Patti Higginbotham, AOCN, APRN Kris Admire, BA.
1
Addressing the Problem of Medication Non-Adherence
Patti Higginbotham, AOCN, APRNKris Admire, BA
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Following this session we will better understand: Medication Non-Adherence Patient Adherence Challenges The Impact of Specialty Pharmacy and Patient Centered
Care Services Patient Education and Support Resources Powerful Touch Points to Engage and Empower Patients and
Caregivers
Session Objectives
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Define medication non-adherence and the challenges contributing to this growing problem
Adherence can be defined as the extent to which a patient’s behavior coincides with medical advice
LaFountain, A. (2010). Adherence: Missing the mark. Retrieved from http//pharmexec.com LaFountain, A. (2011). The forgotten illness. Media Planet, 3 (1), 8.Smith, M. (2013). America’s health care problems? The solutions exist .Managed Care. 22(1), 32-35.Haynes, R.B., Taylor, D.W., Sackett, D. L.. (1979). Compliance in health care. Baltimore, MD: The John Hopkins University Press.
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Multifaceted / Complex issue
Shifted the burden Surprisingly
ignored for a long time
Increasing health costs
Increasing use of complementary therapies
Non- Adherence as a Growing Problem
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“Increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any other improvement in specific medical treatments.”
World Health Organization
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Medication Nonadherence:A Diagnosable and Treatable
Medical Condition
JAMA, May 22/29, 2013—Vol 309, No. 20 pg. 2105
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Compliance Consistency and accuracy with
which a patient follows a regimen
Implies subordinate relationship
Too closely associated with blame
Compliance vs. Adherence
Adherence Defines the extent to which a
patient’s behavior corresponds with agreed upon recommendations
D’Amato, S. (2008). Improving patient adherence with oral chemotherapy. Oncology Issues, July/August, 42-45.
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Primary Secondary Unintentional Intentional
• Trends Web Induced Specialist – FP Lack of motivation/ fear of potential side effects
Types of Non- Adherence
Stefanacci, R., & Guerin, S. (2013). Why medication adherence matters to patients, payers, providers. Managed Care, 22(1), 37-39.
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Patient understanding connection btw adherence and continued health
Patient concluded benefits not out weighing cost
Complexity of regimen Patient factors, forgetfulness Beliefs about medications Perception of medication to have
therapeutic efficacy
Reasons For Nonadherence
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Economics
Patient Outcomes
Identify Why Non-adherence Matters in Healthcare
Stefanacci, R., & Guerin, S. (2013). Why medication adherence matters to patients, payers, providers. Managed Care, 22(1), 37-39.
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Estimated $100 billion in healthcare costs• Readmission rates• Increase in physician visits• Increase in emergency room
visits• Medication adherence is central
to CMS Quality Rating System• Cost of recurrence($11-19,000
over ten years)
Economics
D’Amato, S. (2008). Improving patient adherence with oral chemotherapy. Oncology Issues, July/August, 42-45.SEER –Medicare data 2008
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Compromised Patient Outcomes
Gangloff, J.M. (2013) Troubling trend. Cure Spring
Estimated 125,000 deaths annually in U.S.
Decreased patient satisfaction Poor patient/provider relationships Compromised disease outcomes,
decreased survival Decreased quality of life
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Studies• Demographics• Patient Outcomes
Identify Patient Adherence Challenges and Major Predictors of Poor Adherence to Medication
Ginex, P., Thom, B., Anthony, V., Russell, C., & Gromisch, C. (2012). A pilot study to identify patient factors impacting adherence to oral chemotherapy. Oncology Nursing Forum, 39 (3), E176. Hershman, D. L., Kushi, L.H., Shao, T., Buono, D., Kershenbaum, A., Tsas, W.Y., .,.,., Neugut, A.I. (2010). Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early- stage breast cancer patients. Journal of Clinical Oncology,28(27), 4120-4128.
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1996-2007, examined pharmacy records of 8,769 women
49% completed their full regimen of hormone therapy Women younger than 40, highest rate of
non-adherence • At 4.5 years, 32% had discontinued therapy
Women who had lumpectomy more likely to have discontinued therapy early
Studies: Demographics(Hershman, 2010 )
Hershman, D. L., Kushi, L.H., Shao, T., Buono, D., Kershenbaum, A., Tsas, W.Y., .,.,.,Neugut, A.I. (2010). Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early- stage breast cancer patients. Journal of Clinical Oncology, 28(27),
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Ginex (ongoing study) • Examining factors that may predict which patients are more likely to
follow an oral anticancer regimen
Predictors of Nonadherence
When the world says “Give up,” Hope whispers, “Try one more time.”
-- Author Unknown
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“Nearly one quarter of all people with cancer now use oral medications as part of their
overall cancer treatment.”
“Important Issues in Medication Adherence” Overview Patient Resource Cancer Guide - Medication Adherence 2012 pp. 1Website: www.patientresource.com/medication_adherence_overview
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Specialty Pharmacy: Maximizing Outcomes
Patient Education and Resources: Engaging and Empowering
Support and Communication: Powerful touch points between patients and the extended healthcare team
Bridges to Improve Medication Non- Adherence
2020
“There has been a seismic shift in the way we treat cancer over the last several years & medication adherence has become a serious issue.” (CURE PG 4)
“As oral oncology medications are more widely used, patient adherence issues increase.” (CURE PG4)
“Non-adherence is a growing problem. Now there are many oral oncology medications and the responsibility is completely on the patient to take them or not.” (CURE PG12)
The Landscape in Cancer Care
CURE Supplement to CURE Magazine: “Special Report on Medication Adherence” (2012) Pp.. 4-12
2121
Roughly 125,000 people die each year in the United States because they do not take their medication properly
33-63% of medication related hospital admissions are related to non-adherence and account for $8.5 Billion annually
14-21% of patients never fill their original prescriptions 30-50% of all patients do not properly follow
prescribed medication instructions 12-20% of patients take other people’s medication Prescription drugs represent the fastest growing cost
component for health plans today
Troubling Trends & StatisticsImpacting Medication Adherence
Enhancing Prescription Medication Adherence: A National Action Plan, Bethesda, MD. USA Aug. 2007
The Medication Non-Adherence Epidemic:
A BILLION-DOLLAR HEALTHCARE CRISIS
Three Most Common Factors Forgetfulness Understanding Medication Costs
Dispensing Excellence, Issue 1 -Spring 2013 pp. 1
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Non- Adherent Behavior (Study of 1,020 Adults [40+] taking Prescribed Rx for a Chronic Medical Condition)
% Reporting Behavior
Forget to take Medication 42%
Run out of Medication 34%
Away from Home 27%
Attempt to Save Money 22%
Unpleasant Side Effects 21%
Too Busy 17%
Believed Medication was not needed 16%
Dislike taking Medication 12%
Patient Reported Reasons for Non-Adherence to Medication
Scott, G.N. (2013) Adherence Report Card: Is Patient Tutoring Needed? Medscape. Jul 19,2013
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Pharmacists are Key Partners in the
Future of Healthcare
On a national level, medication
non-adherence costs nearly
$290 Billion annually …
A significant source of waste in
our healthcare system
Anderson, S. (2011). Pharmacists: Reducing Costs, Saving Lives. Media Planet, 3(1), 9-10.
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Specialty Pharmacy Defined*
Often High Cost
Special Handling, Distribution and/or
Administration Requirements
Limited Access
FDA-mandated Risk Evaluation Mitigation
Strategy (REMS) Program
*Adapted from Blaser DA, et.al How to Define Specialty Pharmaceuticals – A Systematic Review. Am J Pharm Benefits. 2010;2(6).371-380.
Specialty Medication
Characteristics
Targets Chronic or Complex Conditions
Specialized Pharmacy Services
Prior Authorization
Patient Copay Assistance
Physician Contact
Proactive Patient Counseling & Education
Side Effect Management
Data / Reporting
Insurance Verification and Coordination of Benefits
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Dedicated Patient Care Team
©2012 Amber Enterprises, Inc., d.b.a. Amber Pharmacy
Nursing Services
In-home injection training Same nurse each time
BillingCoordinator
Insurance review Multiple payer processing
Clinical Oncology Pharmacist
24/7 availability Counseling, side effect
management
Care Coordinator Specialist
Refill reminders & scheduling; delivery follow-up
EnrollmentSpecialist
Coordination of benefits Prior authorization assistance Detailed review out-of-pocket
patient costs Patient assistance programs;
grants and foundations
Patients ALWAYS speak with a
member of their team
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Medication Adherence Effects Quality in Cancer Care
“Quality care is the right diagnosis
and the right treatment in the right environment.”
NCCN Oncology Policy Summit: Measuring Quality in Oncology – Challenges & Opportunities Jul. 2013
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1. The Right Drug
2. The Right Dose
3. At the Right Time
4. On the Right Schedule
5. Under the Right Conditions
6. With the Right Precautions
Key Factors for Proper Adherence
Patient Resources & Cancer Guide – Medication Adherence, Overview, 2012 pp. (1)
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Direct Methods of Measuring Adherence• Direct Observation
• Lab Values & Test Measures
Indirect Methods of Measuring Adherence• Patient Questionnaires & Assessments
• Pill Counts
• Frequency of Prescription Refills
• Patient Journals & Medication Trackers
• Advanced Technology• Smart Phone Apps & Reminders• Rx Bottle Glow Caps
Methods of Measuring AdherenceDirect & Indirect Methods
Osterberg,L.& Blaschke, T. (2005) Adherence to Medication.The New England Journal of Medicine ; 353:489
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MedCoach Medication Reminder• Medications, refill reminders, history, doctors, pharmacies, etc.
Drugs.com• Includes “My Drug List” Drugs A-Z, drugs by condition, pill identifier,
interactions checker, side effects, phonetic search, Q & A, etc. iTriage
• Search symptoms, doctors, hospitals, conditions, medications, health news, etc.
Pill Monitor• Designed to manage pills and medications, pill reminders, history of
taking medications and pill monitor data.
(Logs can be shared by email)
Smart Phone Medication Apps
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Morisky 8 – Item MedicationAdherence Questionnaire
ASK 20 – Adherence Barrier Survey
Medication Adherence Assessments
Morisky DR, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24:67-74ASK-20 Hahn SR, Yu-Isenberg KS, Priest JL, Skinner EP, Weaver MB, Olson PS. A comparison of barriers to medication adherence in patients with chronic conditions. Poster presented at: Society of general Internal Medicine 29th Annual Meeting; April 26-29, 2006
“Communication is the cornerstone of medication
adherence.”
“Important Issues in Medication Adherence” OverviewPatient Resource Cancer Guide - Medication Adherence 2012 pp. 2.
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Patient Education & Resources ProgramAn exclusive program
designed to assist and
support specialty pharmacy
patients and caregivers
dealing with specialized
health conditions
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Patient Care Methods to Improve Medication Adherence
Patient Education
Monitor Dosing Schedules
Communication
Osterberg,L.& Blaschke, T. (8-4-2005) Adherence to Medication. The New England Journal of Medicine; 353:5 491
Patient EmpowermentStories of hope, courage and compassion
Amber Pharmacy - Patient & Caregiver Case Studies; Referenced Organizations & Agencies in Website Bibliography
Farah
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Ruth
Linda and mother, Ann
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Aitken, M. (2013) Avoidable Costs in US Healthcare: the $200 Billion Opportunity from Using Medicines More
Responsibly. Reported by the IMS Institute for Healthcare Infomatics. (5)
ASK-20 Hahn SR., Yu-Isenberg KS., Priest JL, Skinner EP, Weaver MB., Olson PS.
A Comparison of Barriers to Medication Adherence in Patients with Chronic Conditions
Poster presented at: Society of General Internal Medicine 29th Annual Meeting; April 26-29, 2006
CURE Supplement to CURE Magazine – “Special Report on Medication Adherence” (2012) pp. 4-12
Dispensing Excellence Issue 1- Spring 2013 pp.1
Enhancing Prescription Medication Adherence: A National Action Plan, Bethesda, MD. USA August 2007
McKethan,A., Benner, J., Brookhart,A. (2012) Seizing The Opportunity To Improve Medication Adherence”
Health Affairs Blog. August 28th, 2012
Morisky DR, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of
medication adherence. Med Care 1986; 24:67-74
NCCN Oncology Policy Summit: Measuring Quality in Oncology – Challenges & Opportunities Jul. 2013
Osterberg,L.& Blaschke, T. (8-4-2005) “Adherence to Medication”. The New England Journal of Medicine;
353:5 487
Patient Resources & Cancer Guide – Medication Adherence, Overview, 2012 pp. (1)
Scott, G.N. (2013) Adherence Report Card: Is Patient Tutoring Needed? Medscape Jul 19, 2013
Stefanacci, R., & Guerin, S. (2013). Why medication adherence matters to patients, payers, providers.
Managed Care, 22(1), 37-39
Medication Adherence - Bibliography
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Questions & Answers
Thank YouThank You