ADHERTENCE AND COMPLIANCE TO TREATMENTS

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1 ADHERTENCE AND COMPLIANCE TO TREATMENTS Sobhi DADA, MD, FACC, FESC Consultant cardiology Hammoud Hospital- University medical center Saida, Lebanon

2 Adherence Mosby s Medical Dictionary defines adherence as the process in which a person follows rules, guidelines, or standards, especially as patients follow a prescription and recommendations for a regimen of care

4 Medication adherence The degree to which the person s behavior corresponds with the agreed recommendations from a health care provider. World Health Organization

6 Chronic Care Model

7 Global Medication Adherence is 50%

8 Medication adherence 22% of U.S. patients take less of the medication than is prescribed American Heart Association: Statistics you need to know. Accessed November 21, 2007.

9 Percent of patients continually refilling Rx Adherence to statins after two years, by condition 50% 40% 30% 20% 10% 0% 40% Acute coronary syndrome 36% Chronic coronary artery disease 24% Primary prevention Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002;288:

10 Why adherence matters Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year. Results of failure to adhere to prescribed medications: Increased hospitalization Poor health outcomes Increased costs Decreased quality of life Patient death Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:

11 Annual per-patient health care costs Poor adherence increases total health care costs Hypertensive Patients and Total Annual Costs $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $4,850 Received meds, 100% compliant $6,400 Purchased some, but took all purchased $10,500 Purchased some, taken irregularly Smith DL. The effect of patient noncompliance on health care costs. Medical Interface 1993:April; 74-84

12 Why don t patients adhere to their medication therapy? Complex therapies Side Effects Failure to understand the need for the medication High out-of-pocket costs Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:

13 Overcoming barriers to adherence Health plan pays member copay Reduces member out-of pocket costs Emphasizes the importance of continuing therapy Education and outreach Explains the need for medication therapy Breaks down complex therapies into manageable parts Offers strategies for coping with side effects Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:

14 Investment in medication adherence can lead to dramatic reductions in overall cost of care Average health care expenditures per year ($) $10,000 $55 $8,000 $165 $285 $404 $6,000 $763 $8,812 $4,000 $6,959 $6,237 $5,887 $2,000 $3,808 $0 1-19% 20-39% 40-59% 60-79% % Diabetes Medication Level of Adherence (% days supply/year) Rx $ Medical $ Outcome is significantly higher than outcome for % adherence group (P<0.05). Differences were tested for medical cost and hospitalization risk. Sokol M et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. Volume 43, Number 6, June 2005

20 WHO s Five Dimensions of Adherence

21 Self-Management

Improving Adherence to Chronic Medications: The Physicians Role and How 340b Can Help

Improving Adherence to Chronic Medications: The Physicians Role and How 340b Can Help William Shrank MD MSHS Division of Pharmacoepidemiology & Pharmacoeconomics Harvard Medical School wshrank@partners.org