According to previous studies, only about one-half of patients with chronic diseases like hypertension and diabetes adhere to at least 80% of their medication regimens. It can be challenging for healthcare professionals to identify and address adherence barriers in their patients due to the complexity and time constraints of office visits. In many cases, patients may not be asked about adherence to previously prescribed medications or they may fail to fully or accurately describe how well they adhere to treatment.

“There is an information disconnect between physicians and pharmacies in that clinicians don’t know if their patients are actually picking up their medications,” explains Neda Laiteerapong, MD, MS, FACP. “Some patients with low adherence may have their treatments aggressively adjusted by their physicians, but intensifying blood pressure or diabetes medications without considering adherence can become an important safety issue.”

Exploring the Impact of Medication Nonadherence  

Dr. Laiteerapong and colleagues conducted a study, published in Healthcare, that evaluated the impact of medication nonadherence on increases in the intensity of medication regimens for patients with hypertension and type 2 diabetes. “The goals of our analysis were to identify the presence and extent of the problem of medication intensification among patients with low adherence,” Dr. Laiteerapong says.

For the study, pharmacy claims data for Medicare Part D and commercial plans were evaluated for medication fills in patients with hypertension and/or diabetes. Patients had an index fill for hypertension and/or oral diabetes drugs in January 2015. Medication fills in the follow-up period (August 2015-December 2016) were assessed for increases in medication regimen intensity based on the proportion of days covered for 181 days. Differences in the likelihood of experiencing escalations in medication intensity were considered between patients with a proportion of days covered (PDC) lower than 80% versus a PDC of 80% or higher.

Nonadherence Leads to Medication Intensification

Nonadherence in patients with Medicare Part D and commercial plans who filled hypertension and/or oral diabetes medications were significantly more likely to have their regimens intensified. For both antihypertensive medications and metformin, nonadherent patients were more likely to have dosage increases than adherent patients. Nonadherent patients with antihypertensive medication fills and those taking metformin were also more likely to have fills for additional hypertension and diabetes medications when compared with adherent patients (Table).

“Our finding that nonadherence to diabetes or hypertension medications resulted in a higher likelihood of medication intensification raises important safety concerns, especially if patients start becoming more adherent to therapies,” says Dr. Laiteerapong. Since many patients have comorbid diabetes and hypertension, treatment intensification may have compounding effects. For example, patients who do not adhere to their hypertension medications may have a higher likelihood of having their dosage increased, but this can lead to discontinuation of therapy. “Our findings suggest that clinicians should be asking patients how often they’re taking their medications before assuming the next best step is to increase the dose or add another agent,” Dr. Laiteerapong notes.

Wanted: More Pharmacy–Prescriber Collaboration

The study group noted that greater collaboration between retail pharmacies and prescribers could reduce risks for increases in medication intensity in nonadherent patients. Prescribers, health plans, and patients can benefit from prescribers having access to fill-related adherence data at the point of care. Retail pharmacy chains may be able to work with prescribers by providing timely adherence data using systemized healthcare information technology. “We need to develop a system in which medication fill data from pharmacies are front and center for clinicians at the time of prescribing,” says Dr. Laiteerapong. “This type of information may help decrease inappropriate medication adjustments.”

Implementing strategies to improve collaboration between retail pharmacies and prescribers could have a significant impact on patient outcomes. Patients would be the ultimate beneficiaries—with improved adherence, they can meet their clinical goals more efficiently and avoid unnecessary escalations in medication regimens. The overall healthcare system also benefits from improved patient care, a more adherent patient population, fewer unnecessary adverse events, and potentially lower healthcare costs.