How do you solve a problem like medication non-adherence?
Blog Author: Mary De Vera, PhDPosted: Monday, July 15, 2013 - 13:17
I have just started my new job as an Assistant Professor in Medication Adherence at UBC’s Faculty of Pharmaceutical Sciences, a position aimed at targeting medication non-adherence, aka “Canada’s other drug problem.”
Whether it is voluntary or involuntary and whether it is not filling a prescription to begin with, skipping doses, missing refills, or discontinuing medications altogether, patients not taking medications properly is an everyday occurrence. This is problematic when considering the negative outcomes of not taking medications properly, which include unnecessary worsening of symptoms or progression of the condition, increased health care visits, need for more medications, hospitalizations, and even death. The numbers are scary:
• 50%: the proportion of patients with chronic disease who are non-adherent to medications.
• $7-9 billion: estimated annual cost of non-adherence in Canada (in 1995).
• $300 billion: more recent cost estimates from the United States.
• 69%: the proportion of medication-related hospitalizations due to non-adherence.
• 125,000: the number of unnecessary deaths per year due to non-adherence.
I add to these statistics those from my PhD research where I showed that in patients with rheumatoid arthritis, stopping statins increased the risk of a heart attack by 67% and death by 80%.
Beyond these statistics, there are immeasurable impacts on patients and their families. Members of my own family struggle to take their medications properly, especially my grandma. Sharing in her health journey, we have beaten cancer but we can’t seem to beat non-adherence. In her, I see the challenges of managing her many medications (nine at last count) and their many forms of administration as well as barriers to adherence including language, older age, understanding of the need for medications, to name a few. Grandma is the poster patient for non-adherence. She’s also my n-of-1 study subject, my muse, my headache . . . I often think that if I could solve our (her) problem, then I could definitely solve the problem of non-adherence.
So how could this problem be solved? It will take stopping the blame game and looking at non-adherence from a different lens. For example, instead of focusing on the reasons why patients do not adhere, what can we learn from those patients that do adhere? It will take engaging patients, physicians, pharmacists, other health care professionals, and policy makers to build multi-disciplinary teams and provide unique perspectives to the problem. It will take involving not just patients but their support network. It will take borrowing tools from other disciplines and bringing them together. It will take the willingness to create new knowledge.
As someone who has spent my PhD and postdoctoral fellowship measuring and understanding non-adherence and its impacts and one who deals with the problem personally, it is my life’s work and with the Professorship in Adherence at UBC, I have the opportunity to build a dedicated research program on this problem, that will be centered on the values of innovation, collaboration, and rigor. A new researcher/academic could only dream of such an opportunity and I look forward to the important work that lies ahead.
--Mary De Vera, Assistant Professor (Medication Adherence)
UBC Faculty of Pharmacy