Poor Medication Adherence After Hospitalization: Causes and Cures

While everyone would agree that medication adherence is critical to positive health outcomes, the reality is that patients often fail to take their prescribed medications after being hospitalized. In fact, it happens a whopping 50% of the time. Perhaps just as concerning is the fact that 20-30% of the prescriptions are never even filled.

The consequences are sobering:

• Patients with low medication adherence are 20% more likely to be readmitted.
• 125,000 people die prematurely each year due to non-adherence to medications
• Avoidable hospitalizations, nursing home admissions, and premature deaths related to poor medication adherence cost the U.S. healthcare system $300 billion a year.

Why aren’t patients taking their medications as prescribed? There are myriad of reasons.

Cost
Even with insurance, drug costs can be high. This is true especially for medications for chronic conditions such as diabetes, heart disease and high cholesterol. In fact, drug costs increased 10-fold between 1980 and 2018. Patients who have insurance may still find themselves unable to afford co-pays and co-insurance, especially for costly specialty drugs.

Side Effects
The side effects a patient experiences from taking a medication can dramatically increase the chance they won’t take the medication as prescribed. Patients who report side effects are 3.5 times more likely to not take their medicines as directed.

Confusion
Patients often lack a basic understanding of their condition and the reasons behind certain medications being prescribed. When patients don’t understand the benefits associated with taking a medication (or the risks of not doing so), they may just stop taking it.

Misinformation
Patients can convince themselves that taking their medications is unnecessary or too risky. Or, as a patient begins to feel better, they may opt to discontinue taking their meds. Misinformation from a well-meaning friend or the internet can also drive such decisions.

Systemic issues
Despite advancements in record keeping, patients can still fall between the cracks in medical systems. Patients who forget to schedule or attend a follow-up appointment won’t get the care (or the medications) they need. And often, such patients do not have a health care advocate to help manage their care.

Best ways to improve medication uptake

Despite these roadblocks, there are solutions to improve medication adherence after hospitalization. They involve these three primary drivers:

Affordability
When insurance plans reduce drug co-pays or cost-sharing, long-term use of medications increases. Affordability is enhanced by offering drug discount programs, copay assistance or coupons at the time of the prescription.

Disease Support
Providing patients with adequate information about their condition or implementing disease management programs increases medication compliance. Research shows that medication adherence improves by 14% with ongoing education and support (for chronic illnesses).

Electronic Fulfillment
When medications are available electronically, especially through mail order, patients experience both lower costs and more convenience. Some studies suggest that electronic fulfillment of medications increases medication use by 10%.

By implementing strategies like these, hospitals can improve medication compliance among discharged patients, improve longer-term health outcomes and reduce readmissions.