By Megan Headley
There are numerous reasons patients stop taking medication against their physician’s advice. They might feel better (or, thanks to side effects, feel worse). They might not be able to reach the pharmacy. The cost might be too steep. Then, of course, there is the potential for medications to be prescribed from a number of points of care, which is leading to more challenges regarding medication reconciliation. Whatever the cause, poor medication adherence has significant costs for both the individual and the health system.
Medication adherence issues are estimated to cost healthcare facilities approximately $177 billion each year in direct and indirect healthcare costs. According to the 2015 report from the Network for Excellence in Health Innovation, Reducing Hospital Readmissions Through Medication Management and Improved Patient Adherence, “Nearly half of all prescribed medications are not taken as indicated. An analysis of electronic prescriptions for new medications in the U.S. found a 28% non-fill rate, while a recent Canadian study uncovered nearly one-third of new prescriptions were never filled. Inadequate adherence has been linked to poor health outcomes/additional illness, avoidable hospital admissions, premature death and $290 billion in unnecessary health care expenditures annually. Conversely, improved adherence has been linked to better health outcomes.”
But does medication management reduce readmissions? Healthcare systems are exploring a number of strategies to ensure that the answer is “yes.”
Improving medication management at transitions of care
Many hospitals are seeking to improve their medication education at the transitions of care, particularly during the discharge process.
“By definition, any transition of care program that you run, if you are to have a return on investment, has got to have a huge focus on medication issues,” says James Notaro, RPh, PhD, president and founder of Clinical Support Services, Inc., a medication management, care management, and care coordination software and services provider in Buffalo, New York. But according to Notaro, the uncoordinated discharge system puts patients at an immediate disadvantage. When patients are discharged with a stack of prescriptions that the pharmacist must reconcile with previous prescriptions, the hospital is taking a leap of faith that patients will be able to provide for their own care.
“Generally people get a sub-optimized regimen day one out of the hospital—if they get their discharge medications at all; if there are not social determinants of care to prevent them from getting to a pharmacy or filling their particular medication,” Notaro says. He adds, “You’re not at your best when you get discharged from the hospital. If you don’t have good family support, then you’re really in for a sub-optimized regimen after you’re discharged. So for a lot of patients who are fragile, it doesn’t take a long time to return to the hospital.”
As a result, more healthcare providers are examining ways to start medication management programs in the hospital.
Sherri Boehringer, PharmD, BCPS, senior editor and vice president of content at TRC, the Medication Learning Company, sees a “meds to beds” program as one solution for improving medication management. “The idea is that a patient actually gets their discharge medication while they’re still in the hospital and they get education,” she explains. “It’s about ensuring patients go home on the right medications, that there aren’t therapeutic duplications, and that they get the prescriptions they need.”
At Houston Methodist, says Janice Finder, the health system’s director of health and performance improvement, “We provide patients with medication pill boxes prior to discharge and educate them so they or their family is able to fill the boxes.” It’s just one aspect of the systems’ multi-pronged patient education approach.