What Population Health and Care Management Needs to Know About Getting People to Take Their Pills
Posted May 21 2013 8:55pm
Suspecting that the poorly controlled [insert name of chronic condition here] is the result of not taking the medication as prescribed, the doctor says: "Remember to take the [insert name of pharmaceutical here]!"
After silently concluding that the benefit of the medicine is less than the cost, hassles, side effects and long-term risks, the patient thinks "Like hell!"
Marcum et al believe physicians can do better if they understand the six types of behaviors that lead to medicines going unused 1. Insufficient understanding of the link to health and well-being
2. A decision that the benefit is exceeded by the costs.
3. Complexity of the medication management overwhelms the patient
4. Inattention (or what the authors describe as low vigilance)
5. Irrational or conflicting beliefs about medicine
6. Perceived lack of efficacy What does the population health management service providers need to know about this?
1. There are a variety of screening surveys that can be used to identify each of the patterns above; unfortunately for DMCB readers, however, there is no single survey that can do it all.
2. There is also no single intervention that has been shown to consistently increase medication compliance. Instead, multiple concurrent supports are needed, including education and behavioral support. This paper by Ho et al echoes that assessment, pointing out that there is ample evidence that other valuable supports include reducing the number of pills, use of special containers, telemonitoring with interactive voice response, non-physician (nurse or pharmacist) one-on-one involvement and regular clinical follow-up with reminders. Last but not least this paper in the Annals points out that reducing out of pocket patient costs can also make a difference.