Making Medication Adherence “the Fifth Vital Sign”

During an afternoon of specialized pre-meeting sessions at the annual meeting, speakers addressed various aspects of health technology. One presenter, Bernard Vrijens, PhD, of AARDEX Group, stressed to attendees that “Medication Adherence Is a Key Element to Integrate in e-Health.”

The speaker began by quoting former U.S. Surgeon General C. Everett Koop: “Drugs don’t work in patients who don’t take them.” Adherence is key to therapeutic success, Dr. Vrijens said.

He outlined three steps along the adherence journey: Patients must initiate therapy, implement the dosing regimen, and then persist. However, he cited studies that have found 20% to 30% of patients do not initiate prescriptions, 15% do not implement doses as prescribed daily (due to missing a dose, taking an extra dose, or missing a dose), and 40% discontinue treatment by the twelfth month, demonstrating problems all along the adherence journey.

Variable adherence creates drug-specific issues of efficacy, safety, and drug resistance, Dr. Vrijens continued. Suboptimal adherence leads to treatment failure, disease progression, and adverse events, then more complex treatments to address the ensuing issues. It is a complex and expensive loop, he stated, so healthcare practitioners must abandon the “struthian approach” of burying our heads in the sand. Instead, they must better capture true adherence rates and understand the consequences.

“Medication adherence is a vital sign to measure and manage,” he concluded.

Next, Dr. Vrijens reviewed the weaknesses of the available methods to assess adherence in ambulatory patients, including direct methods (measuring pharmacokinetics and pharmacodynamics), self-report, pill counts, and prescription and refill databases (currently the gold standard).

He encouraged the audience to consider the utility of electronic monitoring and institute knowledge at all points of care. He said a systems approach is the only way to successfully combat the problem. Such an approach would involve adjusting health care and prescribing policies; involving the community and other institutions; and educating healthcare practitioners, prescribers, patients, their families, and their friends. One study cited found that awareness of adherence patterns is the best way to change patient behavior, so he proposed using patients’ social networks to make patients aware and more adherent.

Finally, Dr. Vrijens acknowledged that physicians and other healthcare practitioners have heavy workloads and limited resources, so algorithms and systems can help alleviate the adherence problem. However, he stressed that technological solutions do not replace physicians; rather, they redefine their role and require a multidisciplinary approach.

“Healthcare systems must evolve to meet the challenge of achieving satisfactory adherence to therapeutic drug regimens,” he said, guiding attendees to consider patient-tailored approaches, measurement-guided interventions, and e-health.