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Poor Medicine Adherence in Americans with Multiple Chronic Conditions - Anticipating & Addressing a Looming Threat



Agenda-Setting Report Issued to Reduce Adverse Health and Economic Consequences

WASHINGTON, Oct. 15, 2013 /PRNewswire-USNewswire/ -- With mounting evidence that poor medicine adherence will increase dramatically with the projected rise in age-related chronic illnesses, the National Council on Patient Information and Education (NCPIE) - a non-profit coalition of diverse organizations working to improve communication on the safe and appropriate use of medicines - today released a ten-step Adherence Action Agenda that places the spotlight on the pervasive and costly problem of poor medicine adherence, particularly among those age 65 and older with multiple chronic conditions, who are at the greatest risk of medication errors, drug interactions and costly disease complications.

Issued as a nationwide call to action, the report - Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda - finds that poor medicine adherence among patients with chronic and comorbid conditions is resulting in unnecessary disease progression and disease complications and the increased use of expensive components of health care, such as emergency room visits, hospitalizations, avoidable hospital re-admissions and post-acute care. According to estimates cited in the report, caring for approximately 27% of Americans with multiple chronic conditions accounts for 66% of the nation's health expenditures and is a major source of Medicare spending. Of the $300 billion Medicare spent in 2010 on healthcare, beneficiaries with six or more chronic conditions - roughly 14% of the Medicare population - cost $32,658 or three times the national average. As a result, the price tag for treating patients with six or more concurrent diseases was over $140 billion, or almost half of Medicare's total spending.

"Although the challenge of poor medication adherence has been discussed and debated extensively, what is lacking is the clear recognition that prescription medicine use and the rising prevalence of chronic and comorbid conditions are inextricably linked and together, represent a major opportunity to address this health threat," said Ray Bullman, NCPIE's Executive Vice President. "This report is intended as a wakeup call that action is needed now to confront this combined threat, before the predicted continuing upsurge of chronic conditions overwhelms the healthcare system."

Coming six years after NCPIE issued the landmark report - Enhancing Prescription Medicine Adherence: A National Action Plan - which defined poor medicine adherence as the nation's "other drug problem," the new action plan was developed in collaboration with nearly two dozen professional societies, voluntary health organizations, consumer and aging organizations, government agencies and industry leaders and based on evidence that multiple medicine use is commonplace among older Americans, especially those with multiple chronic conditions: 42% of adults aged 65 and older took five or more prescription drugs in 2012 with the average number of drugs prescribed increasing from five at age 65 to seven at age 85. Further, there is a direct link between the number of medications taken by a patient and the risk of adverse drug reactions. Studies document a rise in the incidence of drug reactions from 6% in patients taking two medications a day to as high as 50% in patients taking five drugs a day.

Designed to provide up-to-date information about the state of prescription medicine adherence in the U.S. and the impact of multiple chronic conditions on appropriate medicine use, the report also identifies numerous behavioral, social, economic, medical, and policy-related factors that contribute to poor adherence in this patient population. This includes the complexity of the drug regimen, the need for patients to visit multiple pharmacies to fill different prescriptions, cost-control measures implemented by payers and health systems, poor communication between patients and clinicians, and the breakdown in provider communications during the transition to care from the hospital to the outpatient setting. All of these problems contribute to medication errors, poor health outcomes and higher health care costs and all must be addressed.

Ten New Priorities for Action Intended to accelerate progress in appropriate medicine taking, the new Adherence Action Plan advocates for an increased focus on the overlooked challenge of multiple chronic conditions, where the need for patient adherence is most acute, and lays out these ten policy and programmatic solutions to improve medication adherence:

1. Establish medicine adherence as a priority goal of all federal and state

efforts designed to reduce the burden of multiple chronic conditions.

Because patient adherence is not viewed as an essential element of

government initiatives to reduce the burden of multiple chronic conditions,

the report calls for adherence to be integrated throughout the range of

efforts now underway through a new HHS Multiple Conditions Strategic

Framework to improve health systems change and facilitate new research


2. Establish the role of the patient navigator within the care team to help

patients with multiple chronic conditions navigate the health care system

and take their prescription medicines as prescribed.

Building on the patient navigator model now used in hospitals and cancer

clinics nationwide, the action plan advocates for pairing patients with

multiple chronic conditions with specially trained adherence navigators who

will, in collaboration with patients and caregivers, obtain the patient's

medical records, create an accurate medication list, set up medication

counseling as needed, schedule timely follow-up physician visits, and

facilitate communication between the patient and his or her different


3. Promote clinical management approaches that are tailored to the specific

needs and circumstances of individuals with multiple chronic conditions.

Since patients with multiple chronic conditions differ in the severity of

their illnesses, prognosis, and functional status, the report encourages

health professionals to adopt the American Geriatric Society's guiding

principles for treating older adults with three or more diseases, which

calls for eliciting and incorporating patient preferences and choosing

therapies that optimize benefits and minimize the harm for older patients.

4. Incentivize the entire healthcare system to incorporate adherence education

and medication support as part of routine care for MCC patients.

With research showing that the interactions between patients and their

health care providers affects how well patients manage their chronic

conditions, the report advocates for an expanded investment in

patient/provider education and engagement tools so clinicians can implement

best practices for medication adherence and counsel their patients on the

importance of following treatment plans.

5. Eliminate the barriers that impede the ability of patients with multiple

chronic conditions to refill their prescription medicines.

One of the reasons patients fail to refill their prescriptions is the need

to pick up prescriptions at different times and sometimes at different

pharmacies, requiring numerous trips to the pharmacy. To reduce these

obstacles, stakeholders support implementing the "pharmacy home" model,

which gives patients a single pharmacy point of contact for filling

prescriptions, and adopting refill synchronization, which allows patients

to fill different prescriptions at one time and therefore, reduce the

number of visits they must make to the pharmacy.

6. Reduce the cost-sharing barriers for patients by lowering or eliminating

patient copayments for prescription medicines used to treat the most common

chronic diseases.

The report makes clear that the cost of medications for some patients is a

barrier to filling their prescriptions and taking their medicines as

prescribed and advocates adopting policies that will reduce the

out-of-pocket costs for medications, especially for patients on multiple

prescriptions for chronic condition.

7. Accelerate the adoption of new health information technologies that promote

medication adherence.

Because significant innovations in health technology have the potential to

improve the flow of timely and complete information on medicine use between

patients and providers, the report calls for the swift adoption of new

standards for using electronic health records, incentivizing providers to

use health information technology to identify patients at risk for

medication misuse, and the expanded use of electronic reminders and

personal health records to improve medication adherence.

8. Establish medication adherence as a measure for the accreditation of

healthcare professional educational programs.

Currently, the nation's medical residency programs are moving towards an

outcomes-based accreditation system, where all medical residents will be

evaluated on the basis of required core competencies, including

interpersonal skills and communication. From the standpoint of medication

adherence, this represents an important opportunity to integrate medication

management and e-prescribing into the curriculum of medical residency

programs and paves the way for establishing medicine adherence skills as

core competencies within the curricula of schools of pharmacy, nursing, and

other allied health professions and as a measure for accreditation.

9. Address multiple chronic conditions and optimal medication management

approaches in treatment guidelines.

Clinical practice guidelines typically focus on managing a specific chronic

condition and do not take into account the presence of multiple chronic

conditions. The report advocates the accelerated development of updated

treatment guidelines where information on the most common comorbidities

clustering with the incident chronic condition is included, starting with

the most common combinations of multiple chronic conditions, called dyads

and triads, which have already been identified by the Centers for Medicare

and Medicaid Services (CMS).

10. Stimulate rigorous research on treating people with multiple chronic

conditions, including focused research on medication adherence to promote

the safe and appropriate use of different medicines in this patient


There is a paucity of evidence-based data on how to treat patients with two

or more concurrent diseases who are taking drugs developed and tested in

people who have a single condition. According, the report supports

incorporating medicine adherence throughout the research agenda for

multiple chronic conditions and advocates for increasing the budget for HHS

research efforts on the best ways to treat the most prevalent clusters of

concurrent diseases. About the Report To prepare this new report, in the fall of 2012, NCPIE commenced a new initiative called the Adherence Action Agenda or the "A3 Project," bringing together 22 professional societies and voluntary health organizations, government agencies and industry leaders to identify the major gaps in current adherence efforts and provide input into creation by NCPIE of a new Adherence Action Agenda for the nation. Members of the A3 Project are:


-- Academy of Managed Care Pharmacy

-- Agency for Health Care Research and Quality, Center for Outcomes and


-- American Academy of Nurse Practitioners

-- American Academy of Physician Assistants

-- American Diabetes Association

-- American Heart Association

-- American Medical Association

-- Cardinal Health

-- Council for Affordable Health Coverage

-- Kaiser Permanente

-- McKesson Patient Relationship Solutions

-- Merck

-- National Association of Chain Drug Stores

-- National Community Pharmacists Association

-- National Consumers League

-- National Council on Aging

-- National Council on Patient Information and Education

-- National eHealth Collaborative

-- National Pharmaceutical Council


-- NIH Adherence Network, National Heart, Lung and Blood Institute

-- Pharmacy Quality Alliance Support for development of the Adherence Action Agenda was provided by Merck, known as MSD outside the United States and Canada. NCPIE is solely responsible for the content, and maintains editorial control of all the materials and publications produced for the A3 Project.


Established in 1982, the National Council on Patient Information and Education is a diverse non-profit coalition that works to stimulate and improve the communication of information about the appropriate use of prescription and OTC medicines. NCPIE's members include consumer organizations: patient advocacy groups; voluntary health agencies; health professional associations, schools of pharmacy, health-related trade associations; prescription and over-the-counter pharmaceutical manufacturers; and local, state and federal government agencies. More information about NCPIE is available through its Web site:

SOURCE National Council on Patient Information and Education

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