A Glance at Medication Non-Adherence in the U.S.

Mobile apps that help with medication adherence chip away at a problem that has long beset the healthcare industry.

The World Health Organization (WHO) defines adherence as “the extent to which a person’s behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with agreed recommendations from a healthcare provider.”[1] For one reason or another, many people fall out of adherence. The ensuing physical and financial costs are high.

What’s the Cost of Medication Non-Adherence?

By many estimates, the U.S. racks up between $100 and $300 billion in costs each year due to non-adherence.[2–5]

Hospital readmissions account for $41 billion of the total costs. Research shows that around 66 percent of readmissions stem from non-adherence.[6]

In addition to the monetary loss, non-adherence leads to greater human suffering: worse symptoms, more trips to the hospital, and premature death. [7–10] One study shows that better adherence among people living with hypertension alone could save 89,000 lives a year.[11]

Who Is Non-Adherent?

One in two Americans has a chronic condition.[12]

Most common chronic conditions such as diabetes, hypertension, and asthma can be effectively managed with low-cost medications. Unfortunately, around 50 percent of people taking chronic medications fall out of adherence.[13] And among that group, 50 percent stop taking their pills within the first year.[14]

The mobile health community has the chance to improve the lives of millions of people.

What Causes Non-Adherence?

A report by the Centers for Disease Control and Prevention (CDC) sheds light on why people struggle to adhere. Looking at those with chronic hypertension specifically, the agency lists several reasons for non-adherence.

Not Filling the Prescription (Primary Non-Adherence)
Around 25% of new prescriptions are not obtained by patients. For a deeper look into primary non-adherence, see “Defining and Measuring Primary Medication Nonadherence: Development of a Quality Measure.”

No Symptoms
People with hypertension often don’t have symptoms and thus don’t treat an illness they can’t detect.

Co-payments and other medicine costs are too high for some people.

Side Effects
Medicines may have unwanted side effects.

People are stifled by having to take multiple pills at different times.

Amid the demands of life, people forget to take their medicine or refill prescriptions.

This list doesn’t capture every cause of non-adherence, but it does act as a guidepost. Right now, med adherence apps have the potential to drive big improvements in the “complexity” and “forgetting” categories.

What Now?

People need help managing their chronic conditions. Everyone — doctors, nurses, health insurance and pharmaceutical companies, governments, and beyond — wants people to take their pills. Without a doubt, mobile health apps could lift adherence rates. Success hinges on app developers aligning their product features with evidence-based techniques for changing human behavior.

In future posts, we’ll look at what health experts are saying about today’s med adherence apps. From their main critiques, we’ll pinpoint product development areas in which app creators should invest in 2017 — product areas that will yield the highest gains in adherence at a low cost.

At Neura, we help medication adherence apps increase user engagement with machine learning and artificial intelligence (AI). To learn more, visit Neura’s medication adherence page.

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[1]World Health Organization, “Adherence to Long-Term Therapies. Evidence for Action” (2003): http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.

[2] “Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly,” IMS Institute for Healthcare Informatics, accessed December 16, 2016, http://www.imshealth.com/en/thought-leadership/quintilesims-institute/reports/avoidable-costs.

[3] Regina M. Benjamin, “Medication Adherence: Helping Patients Take Their Medicines as Directed,” Public Health Reports (2012):127(1): 2–3.

[4] Lars Osterberg and Terrence Blaschke, “Adherence to Medication,” New England Journal of Medicine (2005): 353(5): 487–497.

[5] “Adherence Facts,” CVS Health, accessed December 16, 2016, https://cvshealth.com/sites/default/files/Adherence%20Facts.pdf.

[6] “CVS Health Research Institute Study Shows that Medication Reconciliation Programs Can Reduce Hospital Readmissions,” CVS Health Research Institute, July 7, 2016, accessed Dec 19, 2016, https://cvshealth.com/newsroom/press-releases/cvs-health-research-institute-study-shows-medication-reconciliation-programs

[7] Alex J. Adams and Samuel F. Stolpe, “Defining and Measuring Primary Medication Nonadherence: Development of a Quality Measure,” Journal of Managed Care & Specialty Pharmacy, Vol. 22, №5 (May 2016): 516.

[8] D.M. Cutler et al, “The Value of Antihypertensive Drugs: A Perspective on Medical Innovation,” Health Aff (Millwood) (2007): 26(1): 97–110.

[9] Congressional Budget Office, “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services,” (November 2012), accessed December 16, 2016, https://www.cbo.gov/publication/43741.

[10] Walid F. Gellad, Jerry Grenard, and Elizabeth A. McGlynn, “A Review of Barriers to Medication Adherence: A Framework for Driving Policy Options. Santa Monica, CA: RAND Corporation (2009), accessed December 16, 2016, http://www.rand.org/pubs/technical_reports/TR765.html.

[11] David M. Cutler and Wendy Everett, “Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform,” New England Journal of Medicine, 362;17 (April 29, 2010): 1553.

[12] “Adherence Facts,” CVS Health, accessed December 16, 2016.

[13] Seth Heldenbrand et al, Assessment of Medication Adherence App Features, Functionality, and Health Literacy Level and The Creation of a Searchable Web-Based Adherence App Resource for Health Care Professionals and Patients,” Journal of the American Pharmacists Association, 56 (2016): 293, accessed December 16, 2016, http://dx.doi.org/10.1016/j.japh.2015.12.014.

[14] “Adherence Facts,” CVS Health, accessed December 16, 2016.