- Physicians aren’t entirely willing to accept the idea that pouring patient data into their EHRs is an effective way to manage population health, according to a new survey about medication adherence conducted by HealthPrize. Providers seem to overestimate the diligence of their patients while simultaneously believing that high levels of adherence are critical for effective clinical outcomes. Yet 50% of physicians either don’t want any more information about patients than they already have or don’t think it will be all that useful.
Are physicians really resistant to medication adherence programs for their patients, or has the healthcare industry simply not found the right solution to the $300 billion population health management problem?
The 100 primary care providers participating in the survey voiced nearly unanimous agreement that medication adherence is very important for patient care, yet the definition of “adherent” varied widely between respondents. While researchers, academics, and Medicare pin adherence to an 80% rate of possessing and taking medications, physicians tended to disagree. More than 40 percent felt that patients must reach a 90% possession benchmark in order to benefit from therapies for common chronic diseases like high cholesterol and hypertension, but 27 percent felt that the 80% standard was too high a target.
There was also a great deal of variation in responses that may reflect poorly on the PCPs themselves. When asked what percentage of patients never filled written prescriptions, the answers were unsurprisingly low. A third of providers believe that fewer than 10% of their patients ignore their prescriptions, and another quarter think that fewer than 15% of prescriptions end up unfilled.
For patients that do fill a prescription at least once but become non-adherent within the next twelve months, the providers’ estimates were somewhat higher. Thirty-eight percent admitted that between 10 and 20 percent of patients will discontinue their medications without medical approval, and 22% believe that number is more like 30 percent.
Typical rates of initial non-adherence, according to more formalized medical literature, range anywhere from 15 to 30 percent. Twelve-month non-adherence rates can drop down to 50% for chronic disease patients.
The majority of providers indicated that their practice routinely provided medication adherence counseling upon an initial or refill prescription, and providers generally believe that they have a significant responsibility to help patients understand the importance of medication adherence and refilling their prescriptions. The survey respondents are aware of the role that refill reminders and education can play in the struggle to ensure compliance. Thirty-seven percent believe that reminder phone calls have a strong influence on adherence decisions, while more than 20% think text messages and emails or even smart pill bottles could turn the tide for a wayward patient. But many providers don’t seem to want to deal with the patient data that could generate these supportive activities.
Twenty-four percent of the primary care respondents said they didn’t want to receive medication adherence data for individual patients, citing a data overload. Twenty-five percent expressed interest in the information, but were concerned that they could not effectively influence patients to take more responsible actions. One in five PCPs thinks that having medication adherence data would help them engage in predictive analytics and focus their efforts on their highest-risk patients, yet nearly a quarter of providers don’t receive any data about prescription fill rates at all.
Just 44% are currently satisfied with the helpfulness of the data they receive, primarily from health insurance providers and pharmacies. Those respondents added that they spend more time with their patients discussing the importance of staying on track with their treatments.
Population health management data delivered directly to the EHR may not be an attractive prospect for busy providers with plenty to look at on their laptop screens, but physicians are eager for other interventions that would help reduce the burden of non-adherence for them and their patients.
Forty percent believe that financial rewards or copay discounts would be an effective way to boost prescription refills, while nearly three-quarters would be interested in adherence programs sponsored by pharmaceutical companies that were attached to a particular drug. Those providers would be more likely to prescribe that medication than dole out a competitor’s product – as long as the adherence program improved compliance by at least 10 to 20 percent.
The survey indicates that EHR developers and data analytics service providers must find an easier and more attractive way for physicians to receive medication adherence data from a number of sources without overwhelming them with reams of information that will be ignored just as quickly as some patients discard their pills. Understanding the provider community’s attitudes towards utilizing population health management data and devising innovative solutions to better integrate data into the workflow may be key to reducing the costs and clinical impacts of the widespread issue of underutilized medications for chronic disease.