Philip Mandel, a 60-year-old Beaverton man, is a stereotypical Oregon fitness guru. He bikes hundreds of miles a week, hits the gym regularly, and sticks to a low-fat, largely vegetarian diet.
And like hundreds of thousands of his fellow Oregonians, he has had trouble adhering to his doctor’s orders. He recently stopped taking his cholesterol medication for two weeks after experiencing some odd side effects. When his physician found out, he ordered Philip back on the drug to help prevent life-threatening conditions like heart attack and stroke.
Too many Oregonians are still hiking along Philip’s former path of medication non-adherence. It leads to increased hospitalizations and deaths -- and staggering healthcare bills. Fortunately, Oregon health officials can prevent much of this devastation with a few simple reforms that help patients take their medicines as intended.
Oregon, despite its outdoorsy, athletic image, isn’t the healthiest of states. More than 61 percent of residents — about 2.5 million people — suffer from at least one chronic medical condition. For example, high blood pressure — a major risk factor for strokes and heart disease — afflicts one in four Oregonians.
Many of these conditions are easily controlled with medication. High blood pressure treatments, for instance, can cut incidents of stroke by 35 to 40 percent and halve the odds of heart failure.
Yet Oregonians take their pills about as reliably as they drink mass-produced beer. Two-thirds of Beaver State residents fail to follow their doctors’ prescription plans. More than one in five prescriptions goes unfilled.
Stunningly, patients with chronic illnesses — the ones who most need these medicines — are the most likely to skip doses or forgo medications altogether.
Patients who fail to take their medications suffer far higher rates of hospitalizations, surgeries, and hospital stays. Poor adherence to prescribed drug regimens accounts for at least 125,000 untimely deaths in the United States each year.
Non-adherence is also an economic disaster. Oregon spends $4 billion every single year on medication-related problems. Nationwide, adherence costs $105 billion annually.
More than 50 major health-care organizations recently investigated why patients seemingly ignore their doctors’ orders. Surprisingly, only 5 percent of patients with chronic conditions weren’t taking medicines because they couldn’t afford them.
A stunning 92 percent of patients say that simply receiving clear information about the drugs would help them take their medications. Patients also say they’d be more likely to adhere to treatment plans if they received reminders or if they had better discussions with their doctors.
Fortunately, there are several easy steps the Oregon Health Authority and private insurance companies can take to provide residents with better tools to help them take their medicines.
First, they could leverage technology more effectively to identify when prescriptions aren’t filled at the pharmacy. An existing electronic standard that facilitates transactions at the pharmacy counter — called the SCRIPT Standard — could be adopted. Using this standard could allow an email to be sent to doctors when a prescription remains unfilled. That should prompt physicians to follow up and remind patients to take their medicines. SCRIPT also streamlines insurance payments, making it easier for pharmacies and patients to fill prescriptions in a timely manner.
Second, they could implement a Comprehensive Medication Management system. Patients with multiple chronic conditions often receive prescriptions from different doctors. Providers must remain vigilant to ensure the various drugs interact safely with each other and are optimal for the patients’ various medical conditions — and Comprehensive Medication Management gives them the tools and framework to do so.
A CMM pilot program at the University of Southern California slashed hospitalization rates and costs associated with them.
Lastly, officials could start tracking patients’ adherence statistics, in order to better identify at-risk populations and gauge the effectiveness of future healthcare interventions. Most states don’t yet collect such data — which is why Oregon should take the lead on this critical health reform. After all, Oregonians pride themselves on being ahead of the curve.
Far too many deaths, surgeries, and hospitalizations result from patients’ failure to take medicines as directed. Giving doctors and pharmacists a few simple tools to educate patients would drastically reduce non-adherence, improve outcomes and save money for Oregon.
Joel White is President of the Council for Affordable Health Coverage, a national nonpartisan coalition of patients, providers, payers and employers with a singular focus: bringing down the cost of health coverage for all Americans. CAHC runs the 50-organization Prescriptions for a Healthy America campaign that promotes medication adherence. Sloane Salzburg is the Senior Director of Prescriptions for a Healthy America.