The healthcare industry has faced off against medication non-adherence for decades. While there have been intervention improvements, 50% of people are still considered non-adherent.[i] This article provides an overview of medication adherence and argues that human and technology cooperation is the key to solving the adherence problem.
Non-Adherence Overview: The High Costs of Low Adherence
- 70% of Americans have a drug prescription[ii]
- Up to 30% of prescriptions are never filled[iii]
- 50% of patients take their medications incorrectly or not at all[iv]
- Over 115 million Americans are non-adherent[v]
Non-adherence is an epidemic. It affects more people than any of the diseases it’s related to, but most people have never seen these statistics laid out in front of them. We believe that technology is the key to reducing the burdens of non-adherence.
Non-adherence costs the healthcare industry over $300 billion every year. More importantly, it costs at least 125,000 Americans their lives.[vii] These are avoidable deaths, but to stop them, patients require personalized solutions. Medication adherence is about more than just reminding patients to take their medications. Every patient is an individual who has their own obstacles to adherence and it is unfair to assume that forgetfulness or irresponsibility is the driver of non-adherence. If individual barriers to patient adherence can be identified and overcome, then tens of thousands of lives can be saved and millions of dollars can be diverted for other purposes.
It’s About More than Forgetfulness
Based on a survey conducted by the Boston Consulting Group, the top five reasons why patients miss a dose include:
It’s clear that forgetfulness is just a piece of the non-adherence equation. Moreover, missed pills are just one branch of non-adherence. Another factor leading to non-adherence is lack of education. Patients often take their medication incorrectly, at the wrong times, with substances that affect the virality of the drug or they intentionally stop taking pills because they have not been properly educated about why they need them. In fact, “patients recall as little as half of what is discussed during an average medical encounter, contributing to high rates of non-adherence.”[viii] Patients are under a considerable amount of stress during medical diagnoses, but they are expected to remember complex medical directions. Even with doctors’ notes, which they don’t always have or (insert joke about doctors’ handwriting here) struggle to interpret, patients often do not understand how and why they should be taking pills. It gets more difficult the more prescriptions the patient must manage. On average, U.S. seniors take seven different medications a day.[ix] That’s a lot to swallow… Unfortunately, more prescriptions mean more ailments and more information they need to retain, which means more risk for non-adherence.
Identifying Barriers to Adherence Informs Intervention Strategies
The healthcare industry is aware of the non-adherence problem and has long worked to reduce it. Traditionally, the most successful intervention strategies have been face-to-face patient-provider communications and telephone outreach. The latter often includes outreach via in-house or third-party phone calls. These calls are designed to connect with patients and try to determine the cause for medication non-adherence. While human conversation is still the preferred method for patients,[x] it has become increasingly difficult for companies to engage. Phone calls have become less effective as fewer Americans answer the phone and more robocalls deter people from answering unsolicited phone calls. Human-to-human connections are effective when patients connect, but there are still underlying problems:
- It’s hard to scale live communication as doctors and pharmacists can only effectively connect with one patient at a time.
- As membership levels increase it becomes expensive to operate human-to-human communication interventions (even phone calls)
- It is hard to individualize every intervention, so companies are often forced to tackle the issue they believe affects the largest percentage of their population.
Fortunately, technology is improving and over 80% of Americans report having smartphones. Studies prove that the best way to engage members and identify adherence barriers is through multi-targeted connection strategies using a mix of traditional and digital touchpoints. In fact, a recent Accenture study showed that at least 50% of patients now expect digital communication regarding their healthcare interactions.[xi]
Lastly, there are social determinants that keep patients from taking their prescriptions. These might include social isolation, socioeconomic status, or lack of access. These are also factors that patients might be too proud, or hesitant to talk about with a person. Indications suggest that these individuals might be more comfortable providing the above reasons for non-adherence through chatbots or digital surveys, rather than discussing them in person.[xii]
Conversational AI: A New Adherence Frontier
While in-person communication is still the most effective intervention strategy “74% [of patients] aged 18-34 and 62% of those aged 35-54 years believe assistance from mobile health apps or wearable devices would help them be better at taking their medications.”[xiii]
Medication regimens can be confusing for patients and they may have simple questions about things like side effects or interactions. These patients want to know about the drugs they are taking. Every patient also has their own obstacles to adherence and until these obstacles are determined, it’s nearly impossible to initiate an effective intervention strategy for that patient.
Here at Groove Health, we decided that every patient deserves personalized interactions. The only way to achieve this was by using technology to scale our patient reach. That’s why we created our own medical assistant, Maxwell. Maxwell is the first Conversational AI Chatbot for Healthcare. He talks to patients, asks them questions, encourages them, alerts them to potential interactions regarding their medications and, most importantly, he determines the unique obstacles or risks that might keep an individual from adhering to their medications. Once he identifies these obstacles he routes this information to the proper care team or healthcare provider and he provides tailored interventions for the patient. The care team can also access all of this information at any time using their own web portal. They can then ensure that they reach out to the highest risk patients first to ensure that person-to-person communications are used in the most effective way.
Along with alerting the proper people of the potential adherence risks, Maxwell also actively works to educate patients on why their medications are important and how they can combat their own struggles with adherence. This is important because patients who receive educational components within their intervention strategies show adherence increases by up to 92%.[xiv]
Technology can amplify the human touch within healthcare. We’re here to help.
Learn how conversational ai can help you increase medication adherence: Schedule a Demo
[i] Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic Proceedings, 86(4), 304–314. doi:10.4065/mcp.2010.057
[ii] Mayo Clinic. (2013, June 19). Nearly 7 in 10 Americans Take Prescription Drugs. Retrieved from https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/
[iii] Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic Proceedings, 86(4), 304–314. doi:10.4065/mcp.2010.057
[iv] Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic Proceedings, 86(4), 304–314. doi:10.4065/mcp.2010.057
[v] Mayo Clinic. (2013, June 19). Nearly 7 in 10 Americans Take Prescription Drugs. Retrieved from https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/
[vi] New England Healthcare Institute (2009). Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease.
[vii] Zullig, L. L., Blalock, D. V., Dougherty, S., Henderson, R., Ha, C. C., Oakes, M. M., & Bosworth, H. B. (2018). The new landscape of medication adherence improvement: where population health science meets precision medicine. Patient preference and adherence, 12, 1225–1230. doi:10.2147/PPA.S165404
[viii] Boston Consulting Group. (2003, December). The Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and Missed Doses(Rep.). Retrieved https://www.bcg.com/documents/file14265.pdf
[ix] Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic Proceedings, 86(4), 304–314. doi:10.4065/mcp.2010.0575
[x] Brar Prayaga, R., Jeong, E. W., Feger, E., Noble, H. K., Kmiec, M., & Prayaga, R. S. (2018). Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study. JMIR mHealth and uHealth, 6(1), e30. doi:10.2196/mhealth.8930
[xi] Shaw, G. (2019, June 10). mHealth Tools Boost Medication Adherence. Retrieved from HealthTech Magazine: https://healthtechmagazine.net/article/2019/06/mhealth-tools-boost-medication-adherence
[xii] Heath, S. (2019, May 20). Using Social Health to Boost Medication Adherence, Star Ratings. Retrieved from Patient Engagement HIT: https://patientengagementhit.com/news/using-social-health-to-boost-medication-adherence-star-ratings
[xiii] Shaw, G. (2019, June 10). mHealth Tools Boost Medication Adherence. Retrieved from HealthTech Magazine: https://healthtechmagazine.net/article/2019/06/mhealth-tools-boost-medication-adherence
[xiv] Windsor, R. A., Bailey, W. C., Richards, J. M., Manzella, B., Soong, S. J., & Brooks, M. (1990). Evaluation of the efficacy and cost-effectiveness of health education methods to increase medication adherence among adults with asthma. American Journal of Public Health,80(12), 1519-1521. Doi:10.2105/ajph.80.12.1519