Organization has 10 ideas for improving medication adherence

Tailoring clinical management approaches, changing treatment guidelines, investing in education and tools, and revising professional education programs are four of 10 ways that medication adherence can be improved among seniors with multiple chronic health conditions, according to a plan released by the National Council on Patient Information and Education (NCPIE). The results could reduce medication errors, drug interactions and costly disease complications, according to the organization.

Poor medicine adherence is expected to increase dramatically with the projected rise in age-related chronic illnesses, according to NCPIE, and seniors with multiple conditions face the greatest risks. Forty-two percent of adults aged at least 65 years took five or more prescription drugs in 2012, says the organization, with the average number of drugs prescribed increasing from five at age 65 to seven at age 85. Studies document a rise in the incidence of drug reactions from six percent in patients taking two medications a day to as high as 50 percent in patients taking five drugs a day, NCPIE officials add.

“Although the challenge of poor medication adherence has been discussed and debated extensively, what is lacking is the clear recognition that prescription medicine use and the rising prevalence of chronic and co-morbid conditions are inextricably linked and together, represent a major opportunity to address this health threat,” says Ray Bullman, NCPIE’s executive vice president. “This report is intended as a wakeup call that action is needed now to confront this combined threat, before the predicted continuing upsurge of chronic conditions overwhelms the healthcare system.”

Twenty-two entities, including the AARP, the American Diabetes Association, the American Heart Association and the National Council on Aging, helped develop the plan, called the Adherence Action Agenda. Some of the recommendations:

• Promote clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions. Because those with multiple chronic conditions differ in the severity of their illnesses, prognosis and functional status, the report encourages health professionals to adopt the American Geriatric Society’s guiding principles for treating older adults with three or more diseases. Those guidelines call for eliciting and incorporating patient/resident preferences and choosing therapies that optimize benefits and minimize the harm for seniors.
• Establish medication adherence as a measure for the accreditation of healthcare professional educational programs. Medicine adherence skills could be made core competencies within the curricula of schools of nursing, pharmacy and other allied health professions and as a measure for accreditation.
• Address multiple chronic conditions and optimal medication management approaches in treatment guidelines. Clinical practice guidelines typically focus on managing a specific chronic condition and do not consider the presence of multiple chronic conditions. The report advocates the accelerated development of updated treatment guidelines in which information on the most common co-morbidities clustering with the incident chronic condition is included, starting with the most common combinations of multiple chronic conditions, called dyads and triads, which already have been identified by the Centers for Medicare & Medicaid Services.
• Incentivize the entire healthcare system to incorporate adherence education and medication support as part of routine care for those with multiple chronic conditions. Research shows that the interactions between patients/residents and their healthcare providers affects how well they manage their chronic conditions, so the report advocates for an expanded investment in patient/provider education and engagement tools so clinicians can implement best practices for medication adherence and counsel those in their care on the importance of following treatment plans.

Additional suggestions:

• 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 those with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.
• Eliminate barriers that impede the ability of those with multiple chronic conditions to refill prescription medicines.
• Reduce the cost-sharing barriers for people by lowering or eliminating patient co-payments for prescription medicines used to treat the most common chronic diseases.
• Accelerate the adoption of new health information technologies that promote medication adherence.
• 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.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.