admin @ Tue, 2005-10-25 02:46
WASHINGTON, Oct. 24 (UPI) -- Encouraging patients to take their prescription medications as directed is the goal of a new program created by the National Quality Forum.
"Adherence is a longstanding issue and has been a continual challenge to providers, but it's never been directly addressed by the healthcare community before," said Helen Wu, senior project director for the NQF, a private non-profit corporation in Washington established in 1999 to standardize healthcare quality measurement and reporting.
The foundation began the effort in 2004, because of rising evidence that lack of adherence to prescription medication treatment plans has been causing a growing U.S. health crisis and is responsible for 22 percent of hospitalizations each year.
"Our work focuses on the unintentional reasons for non-adherence, like the lack of health literacy that affects 47 percent of American adults," Wu said. "If you don't understand what your doctor is saying about your illness and your medication, you might not take your drugs appropriately. Being told to take a medication twice a day could mean two pills a day, one pill two times a day, or a variety of other things to someone who doesn't know much about healthcare."
The NQF reviewed 600 studies on the subject and found a non-adherence rate of about 25 percent, ranging from 12 percent to 35 percent, depending on the illness. Causes included financial issues, such as the cost of medications and insurance coverage; psychological issues, such as a perceived need for a medication or its unpleasant side effects; inadequate patient-provider communication about an illness or the benefits of the medication, and lack of healthcare literacy, including confusion about basic directions or not knowing how to negotiate the healthcare system.
--Talk more with patients about their medications, encourage them to keep personal medication records, and ask them to bring their medications to appointments.
--Improve written prescription information on packages and inserts by simplifying instructions and providing large-print versions or non-English languages if necessary, and by using standardized, universal symbols on medication labels.
--Take time to talk with patients about their medications to 1) find out if they understand why the drugs are necessary and how they should take them, and 2) uncover the barriers a patient perceives to taking the medication as directed and create strategies to overcome these barriers. Doctors, nurses and pharmacists can all perform such tasks.
--Routinely assess medication adherence as a standard vital sign and include it in medical records.
--Give patients tools they can use to take charge of their medication adherence, such as pill boxes labeled with explicit instructions and electronic reminders from the pharmacy when refills come due.
--Make sure physicians are aware of medication costs and discuss those costs with patients when creating the patient's optimal-care plan.
The American Medical Association fully supports the conclusions of the NQF report. In its Resolution 817, "Patient Adherence to Treatment Plans," the AMA said it "supports the physician's role as the 'learned intermediary' about prescription drugs (and) encourages physicians to incorporate medication reviews ... as part of routine office-based practice."
The resolution also "recognizes the role of the pharmacist in counseling patients about their medicines in order to reinforce the message of the prescribing physician and improve compliance."
The full NQF program, which is described in the report, "Improving Use of Prescription Medications: A National Action Plan," can be found on the foundation's Web site: qualityforum.org.
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