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Coalition seeks to improve meds adherence among most vulnerable

Wednesday October 16, 2013
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In the wake of mounting evidence that poor medicine adherence will increase dramatically with the projected rise in age-related chronic illnesses, the National Council on Patient Information and Education — a nonprofit coalition of diverse organizations working to improve communication on the safe and appropriate use of medicines — released a 10-step Adherence Action Agenda.

The agenda places the spotlight on the issue of poor medicine adherence, particularly among those ages 65 and older with multiple chronic conditions, who are at the greatest risk of medication errors, drug interactions and costly disease complications, according to a council news release.

Issued as a nationwide call to action, the report — “Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda” — finds that poor medicine adherence among patients with chronic and comorbid conditions results in unnecessary disease progression and disease complications and the increased use of expensive components of healthcare, such as ED visits, hospitalizations, avoidable hospital readmissions and post-acute care.

According to estimates cited in the report, caring for approximately 27% of Americans with multiple chronic conditions accounts for 66% of the nation’s health expenditures and is a major source of Medicare spending. A beneficiary with six or more chronic conditions — roughly 14% of the Medicare population — accounts for $32,658, or three times the national average.

As a result, the price tag for treating patients with six or more concurrent diseases was more than $140 billion, or almost half of Medicare’s $300 billion in total spending, according to the news release.

Coming six years after the NCPIE report “Enhancing Prescription Medicine Adherence: A National Action Plan,” which defined poor medicine adherence as the nation’s “other drug problem,” the new action plan was developed in collaboration with nearly two dozen professional societies — including the American Association of Nurse Practitioners — voluntary health organizations, consumer and aging organizations, government agencies and industry leaders.

The report is based on evidence that multiple medicine use is commonplace among older Americans, especially those with multiple chronic conditions: 42% of adults ages 65 and older took five or more prescription drugs in 2012, with the average number of drugs prescribed increasing from five at age 65 to seven at age 85. Further, there is a direct link between the number of medications taken by a patient and the risk of adverse drug reactions, with studies documenting a rise in the incidence of drug reactions from 6% in patients taking two medications a day to as high as 50% in patients taking five drugs a day, according to the news release.

Designed to provide up-to-date information about the state of prescription medicine adherence in the U.S. and the impact of multiple chronic conditions on appropriate medicine use, the report also identifies numerous behavioral, social, economic, medical and policy-related factors that contribute to poor adherence in this patient population. These factors include the complexity of the drug regimen, the need for patients to visit multiple pharmacies to fill different prescriptions, cost-control measures implemented by payers and health systems, poor communication between patients and clinicians and the breakdown in provider communications during the transition to care from the hospital to the outpatient setting.

These problems all contribute to medication errors, poor health outcomes and higher healthcare costs, and all must be addressed, according to the report.

Priorities for action

Intended to accelerate progress in appropriate medicine taking, the new Adherence Action Plan advocates for an increased focus on the overlooked challenge of multiple chronic conditions, where the need for patient adherence is most acute, and lays out 10 policy and programmatic solutions to improve medication adherence:

Establish medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.

Establish the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.

Promote clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions.

Incentivize the entire healthcare system to incorporate adherence education and medication support as part of routine care for patients with multiple chronic conditions.

Eliminate the barriers that impede the ability of patients with multiple chronic conditions to refill their prescription medicines.

Reduce the cost-sharing barriers for patients by lowering or eliminating patient copayments for prescription medicines used to treat the most common chronic diseases.

Accelerate the adoption of new health information technologies that promote medication adherence.

Establish medication adherence as a measure for the accreditation of healthcare professional educational programs.

Address multiple chronic conditions and optimal medication management approaches in treatment guidelines.

Stimulate rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.

National Council on Patient Information and Education: www.talkaboutrx.org


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