When I was a practicing clinician in an urban outpatient clinic, I often saw patients for follow-up appointments only to learn they had never filled the prescription I wrote for them months before. Only during that appointment might I find out why: Cost? Fear of side effects? Confusion or lack of understanding of the importance of taking the medication? At that point, the best-case scenario was getting the patient on the medication several months late. The unfortunate reality, though, is that non-adherence is often only discovered when someone is admitted to the hospital.
The National Institutes of Health estimates that one in three patients never fill their prescriptions—and that’s across categories. Not only do patients experience worse health outcomes when they fail to take their medications as prescribed, but poor medication adherence also negatively impacts the entire healthcare system.
The moment a certain medication is prescribed, any barriers or delays to the patient starting that treatment is essentially just time in which their underlying condition is not being treated. This means their condition can get worse and impact their health outcomes in other ways, resulting in potential escalations such as urgent care, emergency room visits or even hospitalization.
We focus much of our attention on what comes before a patient begins treatment, including looking for ways to increase patients’ access to care and set up thoughtful, thorough treatment plans. But there tends to be less focus on the barriers that influence what happens next. The reality is we have frustratingly few mechanisms to reinforce the patient’s follow-through.
Long before I started working at Phreesia, I wished I had a simple way to reach out to every patient within 24 hours of writing a prescription to check in and basically say, “Did you get that prescription filled yet? And if not, what’s stopping you?”
As we’ve looked closely at this issue, we’ve learned there are three essential components to an effective and automated medication-adherence intervention.
Engage patients the moment a new prescription is written
It’s vital to support medication adherence as soon as a prescription is written to help avoid any potential delays with the treatment plan.
This can be done by sending a digital message via text message or email, depending on the patient’s preference, to remind them they have a new prescription to fill. Ongoing reminder messages are incredibly important, as many patients surveyed by Phreesia said they were not planning to follow through on a refill. We underestimate the value of simple reminders that arrive just in time. These reminders are especially effective with people who were planning to take their medication but just hadn’t yet followed through.
Understand barriers to adherence
Asking patients about the real-world barriers they may face that might thwart their ability to fill and adhere to their prescribed medications is crucial. For instance, financial constraints often make filling and refilling prescriptions more difficult, and logistical issues such as lack of transportation or childcare also can keep patients from getting to a pharmacy or specialized clinic to receive the care they need.
In addition, patients may harbor concerns that keep them from taking certain therapies. Hesitancy around a medication’s method of administration — such as a fear of needles — is common, and in many cases avoidable, if those concerns are expressed upfront. Patients also may worry about a medication’s potential side effects or about becoming dependent on it. Each patient may have their own personal barriers to adherence, so it’s important to discover and immediately address those barriers at the moment the prescription is written to avoid treatment delays and interruptions.
Using technology to consistently survey patients after the visit about their intent to fill their prescriptions can help providers address those barriers quickly and increase the likelihood that patients will get on—and stay on—their medications.
Provide tailored support
Automated reminders can address some challenges immediately. Patients can learn about co-pay assistance and patient support programs, which few patients are aware of. Given the range of medications a clinician prescribes, keeping track of relevant patient support programs in a manual way would be impossible.
Patient education and resources that are personalized to each patient can also address head-on the most common reasons patients don’t fill or refill a prescription. For example, many patients don’t have current symptoms and therefore, filling a prescription seems unnecessary to them. When we survey patients about their intent to fill a prescription, that is the most common reason people cite. Many of the most common chronic conditions, like hyperlipidemia, hypertension and diabetes, are asymptomatic but undertreatment can lead to complications like heart attack or stroke. The risk of life-altering complications like this make it critical to address this barrier.
There have been many attempts to address the challenge of medication adherence. The reality is we won’t be able to solve this problem through more phone calls—especially in the face of ongoing staffing shortages and burnout. We at Phreesia are uniquely positioned to help provider organizations because we reach patients at critical moments in their healthcare journey and support them in taking action. I’m so proud of the work we’re doing in this area and I’m looking forward to sharing more details soon.
Alicia Cowley, MD, MBA, is a physician and a Director of Clinical Content at Phreesia.
