Smoothing the Path

Medication adherence continues to be a challenge for the health care community. Successful treatment of disease simply cannot occur if patients are not adherent to medications. In addition, non-adherence leads to systemic waste. For example, up to 10% of all money spent on health care is attributed to avoidable health care costs linked to nonadherence.

The barriers to medication adherence are a well-studied field, with the reasons for nonadherence primarily grouped into three categories:

  1. Patient-related factors (e.g., forgetfulness, education, financial ability, health literacy, social support, depression)
  1. Provider-related factors (e.g., communication, patient relationship)
  1. External factors (e.g., access to care, disease severity, response to treatment, medication adverse effects, therapy complexity, cost, health insurance)

Understanding the reasons for nonadherence doesn’t, of course, solve the problem. Strategies to overcome each of these barriers is the real solution. For example, for “forgetful” patients, a system of automated alerts can go far. Or a complex medication regimen can be replaced with a simpler therapy, for patients who find this barrier a significant problem. Looking at the entire patient picture is part of our routine care with our patients as we seek to remove adherence barriers.

Interestingly, the way medications reach a patient also affects adherence. Recent research found that medications that arrive through the mail – which is the model of our specialty pharmacy – garner better adherence in patients than picking up medication in person. This study was based specifically on a group of 49,000 post-stroke patients, however it is still intriguing to see how one small barrier – travel to a pharmacy – can alter adherence rates. In-person pick up of medication led to 46.5% adherence, while home delivery correlated with 74% adherence.

Step by step, the health care community continues to make headway in identifying and removing hurdles to patient adherence – with outcomes only the better for this effort.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy


What do you think?

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Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy 2014;7:35-44.

Kim S, Shin DW, Yun JM, et al. Mail order pharmacy use is associated with greater adherence to secondary preventive drugs among stroke patients. Hypertension 2016;67:506-12.

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