Medication possession ratio = Number of days that a drug is supplied / Number of days the drug should be supplied if the prescription was filled per the drug regimen.
Benchmark says >80% is adherent; 80 – 60% is partially adherent; and <60% is non-adherent.
The table below shows rates of medication non-adherence for some chronic conditions:
| Chronic Condition |
Non-Adherence Rates |
| Coronary Heart Disease |
40-50% |
| Hypertension |
15-20% |
| Diabetes: oral meds |
5-60% |
| Diabetes: insulin |
35% |
| Asthma |
25-75% |
| Major Depression |
50-70% |
| Anxiety Disorders |
50% |
| ADHD |
25-50% |
Consequences of not taking medication as prescribed include:
• 125,000 deaths
• $100 billion per year in unnecessary hospitalization costs
• $300 billion per year cost to the U.S. economy
On top of the macro factors, micro factors pertaining to the patient include:
• Unnecessarily high doses
• Illness relapse
• ER usage and hospitalization
So, it begs the question: WHY? Despite all of the above why does non-adherence persist? There can be several factors: the patient is fearful of medication side effects; the patient does not want to take medication because it reminds him of illness; the patient is forgetful. There can be other factors too but these three seem predominant.
Is the solution SMART pill bottle or SMART pill cap? The answer is NO. Studies have proven that SMART devices in enough of themselves do not increase adherence.
Clinician – Patient relationship may impart the most value in improving adherence. Key elements are trust and caring and promoting participation in decision-making. Reminder technology is bound to be part of the solution. However, the technology must be simple to use, leverage an integrated workflow to allow patient’s health information to be viewed in real-time, and enable the physician – patient to be “in-touch” as needed.
Patient behavior cannot be changed overnight – it’s a journey in which the ecosystem of patient, physician, device and data will all have to play a part in unison.
