Today, about half of all drugs for chronic conditions aren’t taken as prescribed, and 20% to 30% of those prescriptions go unfilled altogether. Even for serious diseases like cancer, nonadherence is common- one study found that adherence to oncology therapy can range as low as 46%.
Patient nonadherence of this nature remains one of the most pressing challenges in today’s healthcare system, and is a persistent barrier to patients achieving optimal health outcomes.
What’s Causing Nonadherence?
When patients are expected to bear a greater share of responsibility for managing their own treatment (for example with self-administered therapies or therapies administered at alternate sites of care), -nonadherence becomes more common and more problematic.
To make meaningful improvements in patient adherence, the industry will need to augment the mitigation methods that it has used historically.
A strategic combination of the following three critical elements can help overcome the current barriers that keep patients from realizing the maximum value from their medical treatments:
- A solid understanding of the behaviors associated with starting and remaining on therapy
- Modern, technology-based solutions that facilitate adherence
- Personalized human support
Inside Adherence-Related Behaviors
One significant challenge is that there is no single cause for patient adherence.
The nature of the therapy itself is often one of the most significant stumbling blocks to adherence, especially for specialty therapies. From the combination therapies that are now commonplace in treating cancer, to therapeutics that involve complex or fluctuating titration or administration schedules, patients may struggle to get into a routine or become confused about dosing or timing.
When those patients are dealing with pain or other symptoms of their disease, it often becomes even more difficult to stay on a complicated regimen. Yet if their condition improves thanks to efficacious therapy, patients may become complacent about staying on a complex, long-term treatment plan under the false impression that they have improved enough to discontinue care.
Social determinants of health can also play a role in patient adherence, especially for complex conditions. When therapeutics and supplies are costly—and patients face the simultaneous prospect of losing work time and wages during their course of treatment—the combination of rising expenses and reduced income may lead some patients to skip doses or stop treatment altogether. Other times, something as simple as a lack of reliable transportation can stand in the way of a well-intentioned patient starting or staying on therapy.
A lack of motivation is another common, underlying cause of nonadherence. If the patient isn’t clear on how the medication will improve their health or has doubts about whether the treatment will work, there may be little incentive to go through with therapies that require a significant commitment of time and money. And when the communication between patient and provider is lacking or vague, it can create misperceptions about the value of the therapy to the patient’s overall health.
Side effects and adverse events also can discourage patients from staying on therapy, especially for long-term treatment plans. While oncology treatments in particular can be difficult to tolerate, other disease states often require therapies that can greatly impact the patient’s quality of life. When that happens, the risk of abandonment inevitably goes up.
While no single factor alone may derail a patient’s adherence to therapy, the more factors at play, the greater the odds. One can imagine if a patient’s out-of-pocket costs are high, their treatment is inconvenient to access, the side effects are difficult to tolerate, and the patient is unsure about the treatment’s efficacy, the risk of nonadherence is sure to rise.
A High-Tech/High-Touch Solution
Tackling the multi-faceted issue of patient nonadherence is best accomplished by combining high-tech and high-touch solutions that are designed to first understand the barriers keeping an individual patient from starting or staying on therapy, then remove those barriers as obstacles to strong health outcomes.
On the technology front, a number of modern technologies have the power to help address patient adherence challenges. For example, Human Care Systems (HCS), which CareMetx acquired in 2021, found that an SMS text notification program for neurology patients increased the patient’s likelihood to fill a second prescription by 22% and a third prescription by 47%. A third-party study confirmed this, concluding that text messages improved adherence for chronic disease medications by 36%.
The ubiquitous nature and ease-of-use of text messaging (even in traditionally hard-to-reach communities), coupled with its extremely high open rates, makes this delivery vehicle a powerful tool for improving adherence. Text messaging is useful not only for reminders and notifications, but as a means to drive measurable behavior change through the delivery of relevant, personalized content in small chunks that are convenient to consume.
Other technologies leading the charge to break down patient adherence barriers combine both high-tech and high-touch solutions in a single platform.
For example, merging adherence technology and patient-facing engagement through a single treatment experience platform can empower providers to engage in relevant, personalized, omni-channel interactions with patients. Nurses, physicians, and other health care providers can use well-crafted assessments to identify which adherence barriers are impacting each patient specifically, develop appropriate talking points and interactions designed to overcome those hurdles, and log each point of contact. Robust engagement platforms also can coordinate and streamline the delivery of digital touchpoints that supplement interactions with a human health care provider, using predictive analytics to make every point of contact relevant and personalized.
As patient engagement platforms and hub services technologies continue to advance and evolve, providers can leverage the right balance of high-tech and high-touch tools to support patients at every step of their treatment plan, improve adherence rates, and contribute to better health outcomes even for the most complex diseases and conditions.
For more information, contact CareMetx to learn how our hub services technology and HCS’s patient engagement platform can help you take an effective, comprehensive approach to tackling patient adherence challenges and improving patient outcomes.