Medication Compliance for Patients: A Linchpin to Wellness
Contributed by Elby M. Nash
As the healthcare system faces a perfect storm of issues, an emphasis on patient medication compliance could greatly improve outcomes and reduce spending.
Healthcare costs are skyrocketing because of a “perfect storm” brewing in the healthcare system: High chronic disease levels, increasing costs of treatments and medications, an aging population, high fat diets, and sedentary lifestyles are among the major factors. This confluence demands a more proactive, wellness– and patient–centric approach. A key feature of such an approach is increased patient medication compliance, which would have a great impact on improving outcomes and managing costs.
A recent article in the New England Journal of Medicine stated: “improved adherence can lead to improvements in health outcomes and reductions in healthcare spending. Engaging and supporting patients in improving their adherence is critical to improving health outcomes.”1
Conversely, poor medication compliance results in significant avoidable hospitalizations (estimated at $100 billion annually in the U.S.), increased quality of life issues and degraded task performance among workers. It also negatively affects family members, adding stress and anxiety and further derailing outcomes.
Four Essentials of a Patient Compliance System
Independent studies and limited clinical trials show a strong positive correlation between patient–centered coaching and education and improved outcomes.2 In addition, coaching coupled with mobile technologies has yielded dramatic short–term results.3 The data reveal that the key to improving compliance depends on changing negative patient behaviors through appropriately timed interventions. These interventions may take any of four essential forms:
1. Patient Education and Awareness – Aimed at providing the patient with sufficient knowledge and tools to self–manage medication compliance, nutrition and exercise. This is usually conveyed at the point of initial evaluation and diagnosis. However, evidence suggests improved outcomes among long–term patients receiving “refresher” education five years or more after diagnosis.3
2. Wellness Coaching – Available for some nondeployment related chronic conditions that have serious co–morbidity issues if not aggressively managed; usually provided at initial diagnosis.4 A study of colorectal, breast and prostate cancer survivors concluded that wellness coaching “may decrease psychological distress, improve quality of life, as well as self–reported health behaviors (particularly nutrition and exercise and weight) in cancer survivors.”5 These survivors typically deal with diseases that demand lifestyle changes beyond compliance.
3. Integrated Patient Support Systems – Equip peer, family and medical support systems with the adequate screening tools, procedures and capacity needed to facilitate therapy for patients managing chronic conditions – especially where cognition or mental health issues exist.
4. Social Networks – Networks such as PatientsLikeMe.com and Diabetic Connect are proving to be critical “lifelines” to patients with serious chronic conditions. Social networks allow sharing of experiences and treatment ideas and enable contact among people (beyond providers) who understand the challenges.6
A proactive patient compliance system is a key ingredient in a wellness–based healthcare paradigm. In addition to coaching and education, elements in the larger program would include data capture, monitoring, and analysis.
The benefits of increased compliance will be reaped not only by the patients themselves, but by all stakeholders in the healthcare ecosystem. For pharmaceutical companies, payers and providers, the time to explore and test options for increasing medication compliance is now. They can begin by creating the right incentives at every step and adopting the interventions discussed above. First movers in a fast–moving marketplace will benefit most.
Read the complete white paper, Patient–Centered Wellness: Promoting Savings, Accountability and Health (PDF), or learn more about Cognizant's healthcare solutions.
Footnotes
1Cutler. P, Everett, W, “Thinking Outside the Pillbox: Medication Adherence as a Priority for Health Care Reform,” New England Journal of Medicine, April 7, 2010.
2Bunting, B., Cranor, C. “The Asheville Project: Long–Term Clinical, Humanistic and Economic Outcomes of a Community–Based Medication Therapy Management Program for Asthma,”Journal of the American Pharmacists Association, March–April 2006, Vol 46, No 2, pp 133–147.
3Quinn. C. et al, “WellDoc Mobile Diabetes Randomized Controlled Trial: Change in Clinical and Behavioral Outcomes and Patient and Physician Satisfaction,” Diabetes Technology & Therapeutics, Vol 10, No 3, 2008.
4“Standards of Medical Care in Diabetes,” Diabetes Care, Vol 32, No 1, January 2009.
5Galantino, M., et al, “Longitudinal Benefits of Wellness Coaching in Cancer Survivors,” International Journal of Interdisciplinary Social Sciences, 2010, Vol 4, Issue 10, pp 41–58.
6Miller, C, “Social Networks a Lifeline for the Chronically Ill,” New York Times, March 24, 2010.
About the Author:
Elby M. Nash, Ph.D., is a Principal within Cognizant Business Consulting.