Looking Within the System

Is is possible that the healthcare system itself can contribute to a lack of medication adherence? In a study of managed care organization enrollees for 3 years, individuals went without medications an average of 20.9% of the time. Findings from this study led to further research that found great variations in patient adherence among prescribing physicians. Although no explanation was offered, the findings suggested that there might be a link between patients’ adherence and the behaviors of health providers. This might be explained by a combination of a systems approach (emphasizes how the environment, including health care systems affect patients’ adherence) and the communications approach (this approach views improving provider-patient interaction and patients’ satisfaction as a way to improve adherence).

Here are some examples of Health Care Delivery Systems and Health Care Providers Can Affect Adherence:

• higher co-payment levels are associated with reduced compliance
• pharmacy-based programs, including patient education, medication dispensed using adherence aids such as custom-packaged blister packs, or regular follow-up with pharmacists can improve patient adherence
• good communication between patients and health providers
• higher patient satisfaction with their relationship with the physician will increase adherence

In a study of patient-physician interaction, two thirds of physicians did not even ask their patients any questions about barriers or side effects of their drug use! If physicians would spend a bit more time telling patients about their medications, adherence would most likely go up. There is a definite need to look within the health care system and see what works and what does not work to improve medication adherence nation-wide.

As nurses, we might be able to fill in this gap. If these findings are correct and if physicians are not meeting the educational needs of the patient, then as nurses, we can spend more time educating the patient on how to take their medications properly. We should not only see an increase in medication adherence, we might even seen an increase in patient satisfaction. Who knows, we might even be able to change the system!

See this article from the Journal of Managed Care Pharmacy to read detailed information about these studies!