By Juan Maldonado, MD
It’s estimated that poor medication adherence contributes to 10% of hospitalizations. When patients with chronic conditions—such as diabetes, hypertension, and high cholesterol—do not take their medications regularly, it can be especially harmful. Inconsistent medication adherence puts these patients at higher risk for medical complications, as well as acute interventions. Conversely, if patients follow their medication regimens, they will likely have fewer complications, hospital admissions, and readmissions.
Keeping individuals on track with their medications remains a challenge for many physician practices. Historically, this was the case for my practice as well. Much of our patient population has chronic conditions, with many having more than one. Given the health risks and the persistent socioeconomic challenges that patients in this geographic area face, we believed that increasing their medication adherence rates could help reduce hospitalizations, improve patient health outcomes, and decrease medical costs for patients.
Implementing a program
Several years ago, Valley Organized Physicians—an independent physician association (IPA) with which my practice is affiliated—worked with CareAllies, our IPA’s value-based care management partner, to develop and deploy a Medication Adherence Tracker (MAT). The MAT uses health plan data to identify our most frail patients who have diabetes, hypertension, or high cholesterol and haven’t picked up or refilled their medications. Practice staff can then reach out to these patients to ask about and address potential medication adherence barriers.
Customizing the program for our practice’s population
When my practice implemented the MAT initiative five years ago, we focused on using the prescription refill data as a starting point for conversations with patients. One of the first things we discovered is that some people seem to consistently have difficulties with medication adherence and benefit from regular check-ins. Our medical assistant started reserving one hour per week to make phone calls to patients listed on the report—and just that one hour has made a significant impact.
During the call, she asks how the patient is feeling, whether they are taking their medications, and whether they are having trouble picking them up or having them delivered. She focuses on how we can assist them. People have been open with her about their challenges because they trust her. She’s been with the practice for about 10 years, and our patients know her well. If a patient indicates that a medication is too expensive, she connects them to CareAllies’ pharmacy or community health advocate teams to help identify prescription assistance programs, low-income subsidies, or other benefits that may be available through community-based organizations, their health plan, or other resources.
We also talk about medication adherence with patients at every visit—and a reminder in our electronic medical record prompts these discussions. Our medical assistant introduces the topic when the patient checks in, and then I talk with the patient during the appointment to identify possible barriers and provide education.
Another goal is to make it easier for patients to get their medications. When appropriate, we prescribe a 90-day supply with refills for the entire year, and when possible, we arrange for all their medications to be refilled at the same time. For delivery, we’ve discovered that one size does not fit all. Some people struggle with transportation and want their medications delivered, while others don’t trust the mail system and prefer to pick up their medications. We work to understand what patients’ needs are and then discuss how we can help them receive their medications in their preferred manner.
Lessons learned along the way
We’ve learned that having a good discussion with the patient is key to better adherence. Helping patients understand a medication’s purpose and the importance of taking it consistently is essential. It seems obvious, but we’ve noticed that patients are much more compliant if they understand the reasons behind the medications and how their health and well-being can improve by taking them. We also strive to avoid judgment when people tell us they’re not taking their medication. For many of them, there are other considerations at play. For example, they may not have the money, forcing them to choose between food and medication. Listening and trying to find ways to help is always our goal. Ultimately, we want them to view us as a partner they can trust in improving their health.
Additionally, we noticed patients tend to delay filling their prescriptions at the end of the year. Unfortunately, that can lead to them waiting too long to fill the prescription or misjudging what they have left, leaving them without any medication. To address this, we have conversations with patients about the importance of a new prescription every year and what to do with unused medications.
Along with medication adherence for chronic disease management, we also reconcile medications after every known transition of care, such as after a discharge from a hospital or skilled nursing facility. This has proven beneficial because many changes occur during hospitalizations, including holding and/or discontinuing medications. By ensuring we reconcile medications at these transition times, we can avoid confusion and help the patient consistently take the medications they should.
Our data-driven, patient-focused approach to medication adherence is working well. By using data from the MAT report to guide outreach and conversation, we are seeing more patients regularly filling and taking their medications. Previously, we would review four pages listing names of patients we wanted to monitor. Now, that list is less than half a page long, which shows a vast improvement in our patient population’s medication adherence.
With these outreach efforts, patients feel valued and supported in addressing what can be a complex problem of staying adherent to medication prescriptions. We have worked to identify the gaps in adherence, understand and address our patients’ needs, and simplify the process, all of which has ultimately improved patient health outcomes.
Juan Maldonado, MD, was born and raised in South Texas. After graduating from the University of Texas Southwestern Medical Center in 1996, he settled in Harlingen, Texas, to practice family medicine. He has led a family medicine practice for the past 25 years.