A Publication of Northeast Physicians Hospital Organization  
Initiatives to Improve Medication Adherence


A recent Press Ganey ACO report for the time period of November 2014 through February 2015 for Lahey Clinical Performance Accounts revealed poor performance in Educating Patients on Medication Adherence when compared to other ACOs. Survey questions patients responded to include:

  • Did you and this provider talk about starting or stopping a prescription medication?
  • How often did this provider give you easy to understand instructions about how to take your medications? 
  • Did you and anyone on your health care team talk about how much your prescription medicines cost?

Over the next few months we will be providing educational presentations, articles and discussions on medication adherence for providers, practices and patients in a effort to improve knowledge and impact of medication adherence on healthcare costs, readmissions, treatment failures etc.


Medication Adherence Background:

  • About 20% to 30% of all medication prescriptions are never filled.
  • Only about 50% of medications are taken as prescribed by the provider.
  • Rates of medication adherence drop after the first 6 months of a new treatment.
  • The largest segment of "avoidable U.S healthcare costs" were due to non-adherence in 2013, estimated at $105 billion.


IMS Institute for Healthcare Informatics June 2013


What are the 5 dimensions that influence medication adherence?


Of the five interacting dimensions affecting medication adherence, patient-related factors is only one.  Patient's attitude, beliefs, perceptions, knowledge and expectations strongly influence the success of medication adherence in addition to other dimensions. Social and economic factors affect adherence some of which are poor socioeconomic status, low health-literacy, education and ability to afford medications. Many of these may put the patient in a position of having to financially choose between priorities.


Other factors that affect medication adherence such as complex medication regimens, duration of treatment, previous treatment failures and medication side effects are examples of therapy-related factors. Condition-related factors are those that result from illness demands. Severity of illness, levels of disability and availability of effective treatments are usually beyond one's control for which there are few interventions.  Although there is little research on healthcare team and health system-related factors, data suggests a good relationship between provider and patient has proven to improve adherence.  Other

health system-related factors may contribute negatively to good medication adherence. Lack of knowledge and training of healthcare providers on chronic diseases and effective med adherence interventions as well as systems with weak or no capacity for providing patient education and follow up provide many opportunities for improvement.


Take away:  Awareness of all factors contributing to good medication adherence, particularly the relationship between the provider and patient, helps in reducing health system costs and improving therapeutic successes and patient safety.



Adherence to Long-Term Therapies: Evidence for Action; World Health Organization 2003


Produced by Northeast PHO.  For more information contact: 
Carol Freedman, RPh, MAS, CGP 
Clinical Pharmacist NEPHO 
[email protected] 
Les Sebba M.D., Northeast PHO Medical Director 
[email protected]
August  2015
     Volume 5 :  Issue 5      
In This Issue
 Choosing Wisely Snapshot 
American Geriatric Society recommends:
Don't prescribe a medication without conducting a drug regimen review.


Older patients disproportionately use more prescription and non-prescription drugs than other populations, increasing the risk for side effects and inappropriate
prescribing.  Polypharmacy may lead to diminished adherence, adverse drug reactions and increased risk of cognitive impairment, falls and functional decline. Medication review identifies high-risk medications, drug interactions and those continued beyond their indication.   Additionally, medication review elucidates unnecessary medications and underuse of medications, and may reduce medication burden.  Annual review of medications is an indicator for quality prescribing in vulnerable elderly.


Don't prescribe choline esterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse effects.
Although some randomized control trials suggest cholinesterase inhibitors may improve cognitive testing results, it is unclear whether these changes are clinically meaningful.  It is uncertain whether these meds delay institutionalization, improve quality of life or lessen caregiver burden.  No studies have investigated benefits beyond a year nor clarified the risks and benefits of long-term therapy. Clinicians, patients and their caregivers should discuss treatment goals of practical value that can be easily assessed and the nature and likelihood of adverse effects (GI, urinary frequency, insomnia) before beginning a trial of cholinesterase inhibitors.  If the desired effects (including stabilization of cognition) are not perceived within 12 weeks or so, the inhibitors should be discontinued.

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