A simple way to cut health care costs

The overlooked step in helping patients: 'adherence' to taking one's medicine

By Gordon Bopp

July 29, 2009.

Sometimes the simplest things can make a big difference. For those who rely on the latest innovations in prescription medicine to manage mental health, heart problems, or other medical problems, simply taking their medicines regularly in the manner prescribed by their physician or nurse can have dramatic effects.

It's common sense (if often overlooked) that making sure people have access to medicines and take them as prescribed — known as “adherence” — is an important part of any health care strategy. As such, it may be an overlooked key to saving money in health-care reform. New research shows that adherence is not only good for the well-being of millions across the country but can help reduce the cost of health care. This simple lesson is one Washington's members of Congress should remember as we head into the national debate about health care reform.

Medication adherence is the extent to which the patient follows the doctor's instructions about the timing, dosage and frequency in the utilization of prescribed medicines. However, many patients acknowledge not taking their medicines as directed. According to the New England Journal of Medicine (2004), among patients who actually fill their prescriptions, 50-60 percent don't take their medicines as prescribed, meaning they skip doses, take less than the recommended amount, or stop taking the medicine earlier than they are instructed to do so. This is particularly true of patients suffering from mental illnesses, who often begin feeling better and decide that they no longer need their prescription medications.

The idea of "following doctor's orders" may sound simple enough, but too often the doctor's advice to manage disease through diet and exercise, quitting smoking, taking medications properly, or following other treatment regimens is not followed. The Centers for Disease Control National Health and Nutrition Examination Survey of 2008 found that many cases of chronic disease are undiagnosed, untreated, or uncontrolled. It follows that improving adherence among those with chronic illness can reduce overall health care spending. For example, better adherence to diabetes medications would significantly lower total health spending: for every $1 spent on diabetes medications, $7.10 less is spent on other health care services.

The study in the New England Journal of Medicine backs this assessment up. Researchers found that when patients with chronic illness received prescription drug coverage, they were not only healthier but saved money. While their spending on prescription medicines went up, their overall health costs went down. Adhering to a prescription drug treatment reduced health care costs.

Successful treatment of disease depends on the patient both receiving appropriate medical advice and following it. Pharmacists play an important role in helping patients adhere to prescription labels and to stick with an overall treatment regimen.

Given the obvious benefits, why do so many patients fail to follow doctors' orders? Certainly, some patients are unable to afford treatment costs or co-payments, or lack adequate access to care, especially to preventive care. One 2005 study found that some patients don't follow instructions because they don't understand them. Other patients, especially among older adults, don't experience significant symptoms and therefore think that they do not need to continue treatment. This situation is especially prevalent with patients under treatment for high blood pressure.

This year in Washington state, the Legislature made it more difficult for doctors to prescribe the medicine they think is best for low-income patients. That's meant to be a short-term prescription savings, but it will be outweighed by the cost of treating patients whose illnesses aren't properly managed.

Congress is now crafting a new health care plan addressing many of these issues. Providing consistent access to prescription medicines, especially for low-income families, must be a part of any successful strategy to improve the quality of health care while reducing costs. That's why a number of groups have joined the Partnership to Fight Chronic Disease here in Washington. Chronic disease is a major cost-driver for health care. If we continue to focus on treatment rather than prevention and management, we will continue to lose the battle to control health care costs.

View this story online at: http://crosscut.com/2009/07/29/health-medicine/19133/A-simple-way-cut-health-care-costs/

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