Engaging providers in medication adherence: a health plan case study.

BACKGROUND: Nonadherence to treatment regimens is a common, costly, and complex problem that is often overlooked in a busy primary care setting.
OBJECTIVE: The goals of this study were to raise providers' awareness of nonadherence among their patients, to identify the reasons for lack of adherence, and engage physicians in addressing these barriers.
METHOD: Five primary care practices agreed to participate. The project began in the fall of 2008 with a therapy gap analysis, using prescription drug data from the previous 18 months to identify nonadherent patients. Initially, 237 members were identified as potential nonadherent patients. Each practice was presented with the data related to its patients; the group then narrowed its sample using a chart review and/or patient outreach. Each practice had to determine the barriers to adherence, and was then asked to create action steps to improve patient adherence based on the group's unique results and the specific patient population.
RESULTS: Barriers to adherence identified included prescription drug cost, multiple medications and dosing schedules, and patient as well as family level of understanding and acceptance of disease state. Each group gained an awareness of nonadherence as it related to their patients. For example, in the internal medicine practice, 33% (n = 17) of the patients reported stopping their medication because of cost. A common reason for poor adherence in the pediatric groups was that parents decided to stop their child's medication on weekends and in the summer, without a physician's recommendation. Using such feedback, each practice then developed its own methods to improve medication adherence within its patient population.
CONCLUSION: Although the final numbers in this case study were small, the providers gained valuable insights regarding nonadherence in their practice. This study shows the importance of engaging providers in medication adherence as a way to improve this common problem. Making this universal issue a personal problem for providers is key to overcoming many of the adherence barriers.