Chronic Disease Management

Chronic disease affects 45% of adults in the US—but they take their medication only half the time.1 50% of the prescriptions written for chronic diseases are never picked up.2 60% of patients cannot identify their own medications.3

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Medication adherence has been called the Achilles heel of modern healthcare.4 The average rate of adherence is only 50% after one year and continues to decline.5,6 It is associated with nearly 70% of all medication-related hospital admissions in the U.S., at an estimated annual cost well over $100 billion.7 Nonadherence issues are particularly troublesome with oral chemotherapeutic medications, which are increasingly entering the market, and which often have severe toxicities and narrow therapeutic indices. A review of adherence published in the Journal of the National Cancer Institute found that up to 80% of cancer patients failed to follow their prescriptions.8

Higher adherence has been associated with lower disease-related costs as shown in Table 1.

Table 1. Cost Savings Associated with High Adherence [Reference: Medical Care, 2005, Vol 43, No6, pp 521-530; Sokol MC, Mc Guigan KA, Verbrugger RR, Epstein RS]

The elderly represent an important population among those receiving drug therapy. They receive 30% of all prescriptions and buy 40% of all over-the-counter drugs.9 The inability to manage medications is one of the leading reasons why seniors need additional, often more expensive care.10 Approximately 23% of nursing home admissions are related to medication problems.11

Four medications account for two-thirds of drug-related emergency hospitalizations of older Americans. Researchers looked at 5,077 cases of drug-related adverse events occurring in adults aged 65 or older from 2007 to 2009. Nearly half of all hospitalizations involved seniors 80 or older, and 66% were the result of unintentional overdoses. The four types of medications most often cited in emergency hospitalizations were: warfarin (33%), a blood thinner; insulin (14%), used to control blood sugar in diabetes patients; antiplatelet drugs like aspirin or Plavix (13%), used to prevent clots; and oral diabetes medications (11%). With blood thinners and antiplatelet drugs, bleeding was the main problem; with the diabetes drugs, it was mental effects like confusion, loss of consciousness and seizures.

As payers transition from fee-for-service to "accountable" and value-based models, healthcare providers, Medicare Advantage plans, drug manufacturers and specialty pharmacies will focus on managing the long-term care plans of "their" patients. In order to effectively manage the long term care plans of their patient populations, these organizations must implement advanced medication therapy adherence solutions like eMedonline.

eMedonline significantly improves medication adherence and patient self-efficacy while facilitating disease management. The health decision model suggests that noncompliant behavior is multifactorial.12 By modifying general and specific health beliefs, enhancing social interaction factors, and optimizing administration, compliance can be improved.13,14,15

eMedonline has consistently demonstrated medication adherence levels of 98% in randomized controlled studies among chronic disease patients. Patients in these studies were characterized by significant comorbidity and polypharmacy, and adherence was monitored for up to 6 months. Patients reported extremely high satisfaction with the eMedonline service and user experience in usability testing conducted at the Informatics Laboratory at the National Cancer Institute. They reported that they were better able to manage not only their medications, but also their disease when using eMedonline.

Figure 1. The use case scenario for eMedonline in disease management is shown.

References:

1 World Health Organization (WHO)
2 FDA and National Council on Patient Information and Education
3 FDA and National Council on Patient Information and Education
4 Vermeire E, Hearnshaw H, Van Royen P et al. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics 2002;26:331-342.
5 World Health Organization. Adherence to long-term therapies. Evidence for action. 2003. www.emro.who.int/ncd/Publications/adherence_report.pdf (accessed 2007 Jun 20).
6 DiMatteo MR. Variations in patients' adherence to medical recommendations. A quantitative review of 50 years of research. Med Care. 2004; 42:200-9.
7 Osterberg L, Blaschke T. Adherence to medication. New England Journal of Medicine 2005;353:487-497.
8 Partridge, AH, Avorn, J, Wang, PS, Winer, EP. Adherence to Therapy With Oral Antineoplastic Agents. Journal of the National Cancer Institute, Vol. 94, No. 9, 652-661, May 1, 2002 Oxford University Press.
9 Piraino AJ. Managing Medication in the Elderly. Hospital Practice. Jun 1995; 59-64.
10 "Family Caregiving in the US," National Alliance for Caregiving/AARP, June 1997.
11 Peterson AM, Takiya L, Findley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health-Syst Pharm. 2003; 60:657–65.
12 Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100:258-268.
13 Gabriel M, Gagnon JJP, Bryan CK. Improved patient compliance through use of a daily drug reminder chart. Am J Public Health. 1997;67:968-969.
14 Garnett WR, Davis LJ, McKenney JM, Steiner KC. Effect of telephone follow-up on medication compliance. Am J Hosp Pharm. 1981;38:676-679.
15 Becker JH, Maimann LA. Strategies for enhancing patient compliance. J Community Health. 1980;6:113-135.