This document discusses medication non-adherence and strategies to improve adherence. It finds that 50% of medications are not taken correctly, resulting in increased hospitalization risks and healthcare costs. Case management adherence guidelines (CMAG) provide an algorithm to assess patient knowledge, motivation, and barriers to adherence. Hospitals seek to improve discharge counseling and adherence messaging due to accreditation standards and financial incentives to reduce readmissions. Key elements of successful hospital discharge planning include multidisciplinary teams, protocols, staff education, and measuring adherence programs.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Presentation by Avella Specialty Pharmacy & mScripts at Armada 2015 on improving medication adherence through mobile app technology. Learn about how Avella meets the challenges of medication non-adherence: http://www.avella.com/medication-adherence
Stop TB Partnership focus group session 10-20-17Bruce Thomas
The Arcady Group founder, Bruce Thomas, led the Stop TB Partnership's Focus Group Workshop On Digital Adherence Technologies. At this meeting, innovators such as Everwell Health (99DOTS), Wisepill Technologies (evriMED medication monitor), Keheala (SMS-based behavioral counseling) and SureAdhere Mobile Technology (V-DOT) were connected with representatives of key NGO implementers and country programs (including Zimbabwe, Philippines, Moldova, and South Africa) to discuss opportunities for experimentation and uptake of digital adherence technologies through TB REACH Wave 6 grants. Bruce and Ram Subbaraman shared new evidence and insights about the importance of treatment adherence to avoid TB relapse.
Donors such as the Bill & Melinda Gates Foundation, USAID and Global Affairs Canada are supporting the TB REACH Wave 6 initiative to fund innovation and research to (i) improve detection, linkage to treatment and reporting of TB, and (ii) improve TB treatment adherence and outcomes. Last week, I helped launch the Wave 6 call, presenting an overview of TB adherence technologies and highlighting areas of interest and focus for Wave 6 applicants. To find out more, visit: http://www.stoptb.org/global/awards/tbreach/wave6.asp
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Presentation by Avella Specialty Pharmacy & mScripts at Armada 2015 on improving medication adherence through mobile app technology. Learn about how Avella meets the challenges of medication non-adherence: http://www.avella.com/medication-adherence
Stop TB Partnership focus group session 10-20-17Bruce Thomas
The Arcady Group founder, Bruce Thomas, led the Stop TB Partnership's Focus Group Workshop On Digital Adherence Technologies. At this meeting, innovators such as Everwell Health (99DOTS), Wisepill Technologies (evriMED medication monitor), Keheala (SMS-based behavioral counseling) and SureAdhere Mobile Technology (V-DOT) were connected with representatives of key NGO implementers and country programs (including Zimbabwe, Philippines, Moldova, and South Africa) to discuss opportunities for experimentation and uptake of digital adherence technologies through TB REACH Wave 6 grants. Bruce and Ram Subbaraman shared new evidence and insights about the importance of treatment adherence to avoid TB relapse.
Donors such as the Bill & Melinda Gates Foundation, USAID and Global Affairs Canada are supporting the TB REACH Wave 6 initiative to fund innovation and research to (i) improve detection, linkage to treatment and reporting of TB, and (ii) improve TB treatment adherence and outcomes. Last week, I helped launch the Wave 6 call, presenting an overview of TB adherence technologies and highlighting areas of interest and focus for Wave 6 applicants. To find out more, visit: http://www.stoptb.org/global/awards/tbreach/wave6.asp
Team Lift: Predicting Medication AdherenceNeil Ryan
Medication adherence is a growing public health concern in the US. It is the extent to which patients are taking medications as prescribed by their healthcare providers. Simply put, are patients eating their pills on time?
We looked at patient data from Medicare part D program released by Centers for Medicare & Medicaid services. We built a prediction model to ascertain whether a patient would be adherent based on a variety of social, economic and behavioral aspects.
UTSpeaks: A medicated nation
Has Australia lost its way in a pharmaceutical love affair?
Professor Charlie Benrimoj and Associate Professor Mary Bebawy from the University of Technology, Sydney present at this public lecture on prescription medication held on 13 September, 2011.
How many pills will you take today? Do you really need them? What good (and bad) will they do you?
For many of us prescription medications mean the difference between good and ill-health. There’s no denying their important place in fostering well-being for many. But is it time to reflect on the complex forces at work when managing disease and medications and how this impacts you the consumer?
Featuring leading UTS researchers in pharmacy and using example case studies, this public lecture takes a critical look at how medications are prescribed and consumed in Australia. It considers whether we are getting value for money, the ideal health outcomes we hope for and whether new approaches to the responsible use and explanation of medications could be adopted.
Speakers:
Professor Shalom (Charlie) Benrimoj
Charlie Benrimoj is head of the newly-created UTS School of Pharmacy. Formerly he was Foundation Professor of Pharmacy Practice then Dean of the Faculty of Pharmacy and then Pro-Vice Chancellor (Strategic Planning) at the University of Sydney. He is a visiting professor at the University of Granada with research interests in the future of community pharmacy. He is widely published - co-authoring Community Pharmacy: Strategic Change Management in 2007. He was Australian Pharmacist of the Year in 2000 and received the Andre Bedat award in 2010 from the International Pharmacy Federation.
Associate Professor Mary Bebawy
Mary Bebawy has spent more than 14 years in research and teaching positions in academia and two years in industry as a post doctoral preclinical drug development scientist with Johnson and Johnson, Research. She has consulted to academia and industry on assay development, drug discovery and cancer resistance mechanisms. At the UTS School of Pharmacy she specialises in the role and regulation of the xenobiotic cascade in drug disposition and in cancer multidrug resistance (MDR).
UTSPEAKS: is a free public lecture series presented by UTS experts discussing a range of important issues confronting contemporary Australia.
Use the hashtag #utspeaks to tweet about the lecture on Twitter.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Innovations conference 2014 erica wales does an online anti-cancer medicati...Cancer Institute NSW
Erica Wales - Does an Online Oral Anti-cancer Medication Education Program Targeted at Community Pharmacists Improve their Knowledge and Confidence in Dispensing Oral Anti-cancer Medication
In this paper, we have proposed a novel sequential mining method. The method is fast in comparison to existing method. Data mining, that is additionally cited as knowledge discovery in databases, has been recognized because the method of extracting non-trivial, implicit, antecedently unknown, and probably helpful data from knowledge in databases. The information employed in the mining method usually contains massive amounts of knowledge collected by computerized applications. As an example, bar-code readers in retail stores, digital sensors in scientific experiments, and alternative automation tools in engineering typically generate tremendous knowledge into databases in no time. Not to mention the natively computing- centric environments like internet access logs in net applications. These databases therefore work as rich and reliable sources for information generation and verification. Meanwhile, the massive databases give challenges for effective approaches for information discovery.
Team Lift: Predicting Medication AdherenceNeil Ryan
Medication adherence is a growing public health concern in the US. It is the extent to which patients are taking medications as prescribed by their healthcare providers. Simply put, are patients eating their pills on time?
We looked at patient data from Medicare part D program released by Centers for Medicare & Medicaid services. We built a prediction model to ascertain whether a patient would be adherent based on a variety of social, economic and behavioral aspects.
UTSpeaks: A medicated nation
Has Australia lost its way in a pharmaceutical love affair?
Professor Charlie Benrimoj and Associate Professor Mary Bebawy from the University of Technology, Sydney present at this public lecture on prescription medication held on 13 September, 2011.
How many pills will you take today? Do you really need them? What good (and bad) will they do you?
For many of us prescription medications mean the difference between good and ill-health. There’s no denying their important place in fostering well-being for many. But is it time to reflect on the complex forces at work when managing disease and medications and how this impacts you the consumer?
Featuring leading UTS researchers in pharmacy and using example case studies, this public lecture takes a critical look at how medications are prescribed and consumed in Australia. It considers whether we are getting value for money, the ideal health outcomes we hope for and whether new approaches to the responsible use and explanation of medications could be adopted.
Speakers:
Professor Shalom (Charlie) Benrimoj
Charlie Benrimoj is head of the newly-created UTS School of Pharmacy. Formerly he was Foundation Professor of Pharmacy Practice then Dean of the Faculty of Pharmacy and then Pro-Vice Chancellor (Strategic Planning) at the University of Sydney. He is a visiting professor at the University of Granada with research interests in the future of community pharmacy. He is widely published - co-authoring Community Pharmacy: Strategic Change Management in 2007. He was Australian Pharmacist of the Year in 2000 and received the Andre Bedat award in 2010 from the International Pharmacy Federation.
Associate Professor Mary Bebawy
Mary Bebawy has spent more than 14 years in research and teaching positions in academia and two years in industry as a post doctoral preclinical drug development scientist with Johnson and Johnson, Research. She has consulted to academia and industry on assay development, drug discovery and cancer resistance mechanisms. At the UTS School of Pharmacy she specialises in the role and regulation of the xenobiotic cascade in drug disposition and in cancer multidrug resistance (MDR).
UTSPEAKS: is a free public lecture series presented by UTS experts discussing a range of important issues confronting contemporary Australia.
Use the hashtag #utspeaks to tweet about the lecture on Twitter.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Innovations conference 2014 erica wales does an online anti-cancer medicati...Cancer Institute NSW
Erica Wales - Does an Online Oral Anti-cancer Medication Education Program Targeted at Community Pharmacists Improve their Knowledge and Confidence in Dispensing Oral Anti-cancer Medication
In this paper, we have proposed a novel sequential mining method. The method is fast in comparison to existing method. Data mining, that is additionally cited as knowledge discovery in databases, has been recognized because the method of extracting non-trivial, implicit, antecedently unknown, and probably helpful data from knowledge in databases. The information employed in the mining method usually contains massive amounts of knowledge collected by computerized applications. As an example, bar-code readers in retail stores, digital sensors in scientific experiments, and alternative automation tools in engineering typically generate tremendous knowledge into databases in no time. Not to mention the natively computing- centric environments like internet access logs in net applications. These databases therefore work as rich and reliable sources for information generation and verification. Meanwhile, the massive databases give challenges for effective approaches for information discovery.
BRP Pharmaceuticals is a leader in physician dispensing services that provides instant medication to patients located in Burbank, CA. Visit: http://www.brppharma.com/
The Healthcare Team as the Healthcare Provider: A Different View of the Patie...guesta14581
Presentation to the Ohio State Society of Medical Assistant's annual convention about the Patient Centered Medical Home and the role of the medical assistant
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
VA Diabetes Education Research Study 2008David Donohue
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
1. Medication
Non-Adherence:
The Hidden Epidemic
Managing Medication Adherence and Patient Safety
David R Donohue, M.A., Qualitative Technologies, Inc. Milwaukee, WI
Dr. Tom Muscarello, Ph D, DePaul University, Chicago, IL
2. Henry J Kaiser Family Foundation, 2010
Incidence of Medication
Noncompliance
50%50% of the 3.9 billion prescription
medications dispensed annually
in the United States are not taken
correctly by patients
3. U.S. Patients Do Not Take
Medications as Prescribed
100%
76%*
88%
47%*
Rx prescribed Rx continuedRx takenRx filled
-12%
-12%
-29%
* 22% of U.S. patients take less of the medication than is prescribed
American Heart Association: Statistics you need to know. http://216.185.102.50/CAP/pro/prof_statistics2.html. Accessed July 27,
2009.
4. Impact of Medication Adherence on
Hospitalization Risk
0
10
20
30
40
50
60
1-19* 20-
39*
40-
59*
60-
79*
80-
100
Medicat ion Possession Rat io
Diabetes Hypertension Hypercholesterolemia
*P<0.05 when compared to the 80-100% group
HospitalizationRisk
Sokol etal. Med Care 2005;43: 521-530
5. Impact of Medication Adherence on All-
Cause Healthcare Costs
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000HealthcareCost
1-19* 20-39* 40-59* 60-79+ 80-100
Diabetes Hypertension Hypercholesterolemia
*P<0.05 when compared to the 80-100% group
+ P<0.05 when compared to the 80-100% group in Diabetes and Hypercholesterolemia
Patients
6. Potential Barriers to
Improving Adherence
Poor attitude
Memory deficits
Language
Poor Literacy
Cultural beliefs
Alternative health
beliefs
Poor support
Pride
Denial
Fear or
embarrassment
Side effects
Religious beliefs
Unable to “see”
results of drug
therapy
Lack of choices
Rising Cost
Vermiere E, et al. J Clin Pharm Ther. 2007;26:331-342.
7. What is CMAG?
Developed from concepts presented by the World
Health Organization (WHO) 2005.
Case Management Adherence Guidelines
or CMAG provides an interaction and
management algorithm to assess and improve the
patient's knowledge and his/her motivation to take
medications as they are prescribed.
The guidelines provide great flexibility in that
individual patient needs can be taken into
account.
8. WHO White Paper on
Adherence
The World Health Organization has made a strong case
that medication adherence is based on three pillars:
patient information, motivation, and behavioral skill
requirements.
Adherence to Long-Term Therapies: Evidence for Action. WHO 2006
11. Health Literacy
Health literacy is defined as the ability to
read, understand, and act on health
information.
Poor health literacy results in medication
errors, impaired ability to remember and
follow treatment recommendations, and
reduced ability to navigate within the
healthcare system.
The Rapid Estimate of Adult Literacy in
Medicine-Revised (REALM-R), a brief
eight-item Health Literacy screening test
12. Bass Pf, Wilson JF, Griffith, CH. J Gen Intern Med.2003;18:1036-1038.
13. Medication Knowledge
Survey
Assesses knowledge of various
medications to be taken, their
dosing schedule, benefits and
storage
Useful as part of the knowledge
assessment for CMAG to determine
if the patient is in the high or low
knowledge domain
14.
15. CMAG Assessment Tools
Tools to assess patient motivation
Readiness Ruler
Duke-UNC Functional Social
Support Questionnaire
16. Readiness Ruler
Assess willingness to change behavior
Zimmerman GL, Olsen CG, Bosworth MF. Am Fam Physician.2000:61;1409-1416
17. Social Support
Family or social support is a significant
predictor of adherence to long-term
medical therapy
Duke-UNC Functional Social Support
Questionnaire
Eight-item, self-administered,
multidimensional instrument
Broadhead WE, et al. Med Care.2006:27;221-223.
18.
19. Modified Morisky Scale
Patients on existing therapy
Morisky 4 item validated adherence predictor
scale
Two new items to recognize patient
understanding of medication benefits as well as
refill behavior
Allows patients to be categorized as either High
or Low on Knowledge and Motivation domains
Morisky DE, Green LW, Levine DM. Med Care. 1986;24:67-74.
22. The Hospitalized Patient
Acknowledges patients higher level of
acuity
Case managers are used with only a
small percent of inpatients
Case managers & Nurses have a
decreased period of time to interact
and plan positive interventions with
their patients
23. Successful Discharge
Collaboration with other healthcare
providers both within and outside
the inpatient setting is extremely
important to ensure a Successful
Discharge and long term health
outcomes.
24. Steps to Ensure a
Successful Discharge
Educate the patient and ensure patient
understanding on their diabetes disease and
other chronic disease process and factors that
can influence their medical condition
Ensure patients have the resources to manage
their diabetes and other chronic diseases after
discharge from the hospital
Make certain that the discharge will be “safe” for
the individual patient
Ensure that the patient understands the plan for
transition of care into the post discharge setting
Make certain that the patient has access to the
follow up care and therapy
25. Information for Patients to Ensure
a Successful Discharge
Patients that are educated regarding their
diabetes and other chronic disease treatments
are more likely to remain adherent to treatment
recommendations
Patients discharged from the hospital with new
medications must be monitored for compliance
followup
26. Information for Patients to Ensure
a Successful Discharge
Medications that are prescribed during
hospitalization need to be reconciled with other
medications.
Patients need to know how to monitor their
diabetes and other chronic diseases and
treatments in an outpatient setting.
27. Questions: Addressed With Patients
Prior To Discharge
What is wrong with me and what will this
condition mean to my long-term health?
What do I need to do when I get home to treat
my condition successfully?
Who should I contact if I have questions
regarding my treatment after I am discharged?
What are things that I need to watch for to know
if my condition is getting worse and what should
I do if these occur?
How will I pay for my outpatient medical
supplies or services? What resources are
available to me?
28. Why discharge counseling and adherence
messaging are important for the hospital?
Maintain Accreditation
JCAHO, NCQA, CMS
Successfully compete with other hospitals in the
community
Patient satisfaction levels are increased
Publicly available quality rankings
Financial
Prevent readmissions, and charge backs
Promote timely hospital patient discharges
29. Competitive Advantage for Hospital
Discharge Planning
All hospitals seek to be viewed as providing an
outstanding level of patient care
Hospitals work to maintain a high level of
patient satisfaction
Discharge counseling is one of the last points of
contact with the patient
Patients and payers can now easily compare
quality indicators on hospitals in their
community
www.hospitalcompare.hhs.gov
www.jcaho.org/quality+check/home.htm
30. Current State of Hospital Discharge
Counseling and Adherence Messaging
Studies of patients recently discharged from
the hospital have found that:
< 50% of patients could state their
diagnosis accurately
< 50% of patients could list all their
medications
< 25% of patients could state common side
effects, and what to expect from their
medications
Patients taking three or more medications
were more likely to have problems with
medication knowledge and scheduling
King, 1998; Makaryus, 2007
31. Key Elements of Successful
Discharge Planning
Recruit a champion or mentor
Build a multidisciplinary hospital team
Review ALL baseline data
Develop protocols and order sets that include
appropriate evidence-based therapies
Conduct hospital staff conferences to introduce
process and gain buy in from all stakeholders
Continue data analysis and report results back to
hospital staff on a regular basis
Evaluate data and look for opportunities for
improvement at all levels
Create an medication adherence program and
measure it
AHA, Get with the Guidelines
33. Transition of Care to the
Outpatient Setting
Involve family and all caregivers in patient
education
Ensure that each patient has a plan for
outpatient follow up
Facilitate referral for outpatient services and
healthcare providers
Assist patients with resolving issues relating
to the cost of outpatient services and
treatments
Evaluate Adherence Intention prior to
discharge using CMAG tools
Editor's Notes
Power Point completed December 2010.
Reference: Henry J Kaiser Family Foundation, 2009. The effect of patient noncompliance on health care costs.
Intent of Slide: Increase audience awareness of the prevalence of medication noncompliance in the U.S.
Expand upon the opportunities available for the pharmacist to intervene and increase medication compliance through patient counseling and follow-up.
This is a conceptual slide, based on statistics from the American Heart Association.
Here you can see non adherence broken down by behavior and quantified. As you can see, there is a progression of non adherence that starts with not filling the prescription (12%). Then there are those that fill the prescription, but do not take the medication (12%). Then there are those who take the medication, but do not persist with it (29%). And within the percentage of patients that take their medications, there are 22% that take less than is prescribed. So according to this information, only 25% of those who are prescribed medication actually take it like they should.
How does this affect patients?
The impact of medication adherence on the estimated all-cause hospitalization risk based on regression analysis.
Results indicated that the outcome was significantly higher than the outcome for the 80-100% group (P&lt;0.05)
In the public debate over sky rocketing prescription drug costs the potential economic return s are often missed. These results demonstrate that a net return may be obtained for 3 chronic conditions that account for a large share of long term medication use. In this slide statistically significant differences were seen in the hospitalization risk in patients that had a lower adherence level compared to those with adherence levels from 80-100%
Other Notes: The study consisted of 137,277 patients under age 65
Measures included disease related and all cause medical costs, drug costs and hospitalization risk were measured. Using regression analysis these measure were modeled at varying levels of medication adherence. Medication adherence was defined by days’ supply of maintenance medications for each condition.
The estimated all-cause healthcare costs based on regression analysis
In the public debate over sky rocketing prescription drug costs the potential economic returns are often missed. These results demonstrate that a net return may be obtained for 3 chronic conditions that account for a large share of long term medication use. In this slide statistically significant differences were seen in the hospitalization risk in patients that had a lower adherence level compared to those with adherence levels from 80-100%
Other Notes: The study consisted of 137,277 patients under age 65.
Measures included disease related and all cause medical costs, drug costs and hospitalization risk were measured. Using regression analysis these measures were modeled at varying levels of medication adherence. Medication adherence was defined by days’ supply of maintenance medications for each condition.
Some of these barriers are more easily overcome than others. (i.e. support can be provided externally but cultural and religious beliefs are deeply ingrained and difficult to bridge).
Collaboration is vital at all levels to ensure that the appropriate patients are referred to case management. Therefore, case managers need to work closely with other healthcare professional to ensure appropriate referral.
Doctors, nurses, clinicians and family and friends all need to be on the long term care team of the patient.
CMAG 2 has coined the term, “Successful Discharge,” for patients receiving appropriate Discharge Planning services.
Patients that receive the appropriate steps that lead to a Successful Discharge will be more likely to manage their disease outside the hospital. This will decrease the chances of the person needing to be readmitted to the hospital for acute exacerbations of chronic conditions and complications related to procedures. Since hospitalization is frequently the most expensive part of the treatment, this will help in controling overall healthcare expenditures.
There are many individuals that may be involved in the discharge planning process. These individuals can be divided into lay individuals that provide support for the patients and those that are involved with the provision of healthcare services.
Involvement of family and friends especially important for interventions involving lifestyle modifications.
Thank you, David R Donohue, M.A. Qualitative Technologies, Inc. and Dr Tom Muscarello, Ph D, DePaul University, Chicago, IL