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Why Drugs Don’t Work. Adherence, Compliance and MTM

“These Drugs don’t work”. We hear that all the time. Yes, some of them unfortunately don’t. However, most of the time drugs do not work simply because they do not interact in a beneficial way with each other. Secondly, the majority of patients do not adhere (only 25% of patients take their medications exactly and for as long as prescribed (American Hearth Association: Statistics you need to know.). The other 75%  cost the healthcare system up to $290 billion in avoidable costs (The New England Journal of Medicine ).

For these 2 reasons, drugs don’t work. The question is really why do these two reasons exist in the first place? When the drug is prescribed relatively few health professionals discuss with their patients possible interactions with other medications or herbal supplements (for example, a survey of 100 patients taking the anticoagulant warfarin found that 69% of patients take of some kind of herbal or dietary supplement, but only 35% report that their healthcare provider asked them about supplements).

And why do patients not adhere? Although I am not an expert in the field, my homework in this area indicates a lack of medication reconciliation on the clinician side and lack of incentives on the patient side, further fueled by a lack of education and guidance from the experts (including pharmacists and providers).

The first problem, medication reconciliation, is well summed up by a recent post by John Halamka about Smart Medication Reconciliation and Problem Lists: patients (his parents) received unnecessary medications as well as did not receive necessary ones because of the challenges of retrieving their history of active as well as non-active  medications. Disparate data silos across our healthcare systems DO NOT talk with each other: Neither physicians nor pharmacists are able to grasp the whole picture of a medication history; herbal supplements taken by many are not discussed with the healthcare provider; discharged inpatients do not discuss the medications s/he is still on with their local physician/pharmacist who prescribes and dispense new drugs, etc. etc. – there are many examples of how different databases do not exchange patent’s related and holistic health information.

The problem of non-adherence comes down to a lack of communication, guidance, education, and support, as well as lack of time, human resources, an inappropriate reimbursement system and lack of “smart” technical tools to assist and help the providers. Communication, guidance, education etc. can easily be performed by a community pharmacist – a certified provider who often already has a personal relationship with his/her patients.

“Smart” decision-support tools available to the pharmacist, ongoing personal/phone communication and follow ups, medication review/reconciliation/optimization/suggestion, educational materials, support 24/7/365 through alerts going directly to the provider, a shift from time- and cost-inefficiency, labour-intensity and limitations of current MTM (Medication Therapy Management) services to a comprehensive, outcomes-based, personalized therapy which considers lifestyle and wellness factors while determining the most appropriate therapy. A wise and timely combination of all these activities will deliver results: improve adherence (reducing overall healthcare costs) and better health outcomes while putting the pharmacist  – a trained medication professional  – at the forefront and letting him/her effectively utilize valuable skills for the benefit of all the parties involved.

Yours in health,

Hamish

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