The Challenge of Staying Adherent to Complex Therapies

Patients with chronic conditions are likely to have multiple doctors and take nearly a dozen medications—sometimes filled in at least two different pharmacies, and it is resulting in many patients struggling to keep their medications straight, according to new research from Brigham and Women's Hospital and CVS Caremark.

The study, published in the Archives of Internal Medicine, concluded that the health care system needs to find ways to help patients simplify, synchronize, centralize, and organize their medication management. Among the solutions proposed is the creation of a "pharmacy home" to coordinate pharmacy care from a single point of contact.

"Consolidating prescriptions in a single pharmacy home may help improve health care quality similar to the intended effects of a patient-centered medical home," the researchers said. In addition, the researchers said there is a need to synchronize medication regimens for patients because "those who make numerous trips to the pharmacy to pick up their medications, or fill prescriptions at different pharmacies, may have difficulty taking their medications as prescribed."

"The complexity that typical patients with heart disease face when trying to manage their medication treatment regimens is nothing short of dramatic," said Niteesh K. Choudhry MD, PhD, of Brigham and Women's Hospital, lead author of the study, in a press release. "While the treatment of chronic disease is extremely complex, our results clearly demonstrate filling prescriptions at many different pharmacies on many different occasions makes it even harder for these patients to take their medicine as directed by their doctors."

Although it might not be surprising to many that patients who have multiple physicians and take medications purchased from multiple pharmacies are less likely to be adherent, “these findings show that the health care system needs to do a much better job helping these patients consolidate and manage their pharmacy care if we are intent on improving their health outcomes,” said Larry Merlo, president and chief operating officer of CVS Caremark.

The study reviewed pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins, and 1.48 million patients taking angiotensen converting enzyme inhibitors or rennin angiotensen receptor blockers (ARBs) between June of 2006 and May of 2007.

During a three-month period, patients filled prescriptions for an average of 11 medications representing an average of six different drug classes, the researchers said. "More striking, during this 90-day time frame, 10 percent of these patients filled prescriptions for 23 or more medications… and 11 or more different drug classes, had prescriptions written by four or more prescribers, filled these prescriptions at two pharmacies and made 11 or more visits to those pharmacies," they said.

Among solutions discussed in the study are:

• Creating a centralized pharmacy home where a patient's pharmacy care is evaluated and renewals and refills are better synchronized and managed. This could include providing financial incentives for patients to fill prescriptions at a single pharmacy, so that a single health care professional has a full view of the patient's needs and care.
• Encouraging programs that reduce complexity of both filling and taking medications by streamlining the number of trips it takes to fill their prescriptions through programs like 90-day versus 30-day prescriptions and coordination through mail order pharmacies.
• Experimenting with programs and technologies that may make it easier for patients to better organize their medications.

To read the Archives of Internal Medicine study, click here.