The Unmet Challenge of Medication Nonadherence
“Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Despite this, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem. Much of the literature on nonadherence focuses on barriers to adherence, with the assumption that appropriate adherence is the normal course of events and nonadherence is an aberration.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/
Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories
“On any day, patients who were still engaged with the drug dosing regimen omitted about 10% of the scheduled doses: 42% of these omissions were of a single day’s dose, whereas 43% were part of a sequence of several days (three or more days—that is, drug “holidays”). Almost half of the patients had at least one drug holiday a year. The likelihood that a patient would discontinue treatment early was inversely related to the quality of his or her daily execution of the dosing regimen.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386633/
Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis
This EU-sponsored study confirms that showing patients their own dosing errors is the most effective means to improve adherence. “Seventy-nine clinical trials published between 1995 and December 2011 were included in the review. Patients randomized to an intervention group had an average combined adherence outcome of 74.3%, which was 14.1% higher than in patients randomized to the control group (60.2%). The linear meta-regression analysis with stepwise variable selection estimated an 8.8% increase in adherence when the intervention included feedback to the patients of their recent dosing history (EM-feedback) (p < 0.01) and a 5.0% increase in adherence when the intervention included a cognitive-educational component (p = 0.2).”
https://link.springer.com/article/10.1007/s40265-013-0041-3
Current Situation of Medication Adherence in Hypertension
“Patients’ awareness of their adherence patterns can change their behavior (Vrijens et. al., 2006). The key elements to changing patients’ behavior include: education, motivation, and measurement (Vrijens et al., 2014). Packaging is an underused opportunity to effectively manage medication adherence. It has a role to play in measurement and provision of information. The ESH/ESC guidelines include reminder packaging as a method of improving adherence to physicians’ recommendations (Mancia et al., 2013). A real-world assessment of the impact of reminder packaging in the US has shown that it can improve rates of adherence and persistence to antihypertensive treatment (Dupclay et. al., 2012). A higher proportion of patients who received their prescribed medication in reminder packaging remained on treatment and were less likely to discontinue therapy compared with the non-reminder packaging group.”
https://www.frontiersin.org/articles/10.3389/fphar.2017.00100/full#B9
High-fidelity measurement of patients’ medication adherence: A missing link in precision medicine
“Achieving satisfactory adherence may have far greater impact than any other maneuver, and healthcare systems must evolve to meet this challenge.”
Studies show reminder packaging empowers adherent patients to stay adherent and increases adherence rates by more than 14%.*
The “Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis” study found adherence rates averaged 60.2% in the control group and 69.0% in the intervention group that provided feedback to patients of their recent dosing history. This 8.8% (69.0% - 60.2%) nominal increase in adherence rates equals a 14.6% (69%/60.2%) increase in percentage terms.
Real-world implementations of reminder packaging suggest its impact on adherence rates may be significantly higher than 14.6%, as the adherence rates for birth control pills, which have relied on reminder packaging to set patients up for success for more than 60 years, are above 95%.
However, despite the overwhelming evidence that reminder packaging works when given to adherent patients, to date the health care system has failed to embrace it, continued to rely on traditional packaging, and viewed nonadherent patients as the problem that needs to be fixed. And because reminder packaging interventions have failed to make nonadherent patients, adherent, health care decision makers have mistakenly concluded it doesn’t work. All of which suggests we won’t increase adherence rates until we commit to interventions that target adherent patients. And the easiest way to do this is by replacing traditional medication packaging with reminder packaging.