I had the pleasure of sharing a podium this week with Dr. Daniel Teres, Senior Director, Field Medical Physician, at AstraZeneca Pharmaceuticals, to discuss the topic of adherence to medication. We used the August 4, 2005, NEJM article by Osterberg and Blaschke as our starting point, but then went on from there to explore the topic more fully.
Regular readers with a good memory will recall that I covered this topic three years ago, quoting George Paz, CEO of Express Scrips. Well, Daniel had similar numbers to report, citing a study showing that after one year, only half of all patients with chronic conditions are taking medications as recommended by their doctors. While the NEJM article gives some of the reasons, he also explained some additional ones.
Denial of disease heads the list among patients with some conditions. Clinical depression is another. The stigma of the disease is another (e.g., among those taking psychiatric drugs.) Complexity of the prescription regime is another: "One per day is the best," he noted.
Daniel asked the audience to guess for which disease there is virtually 100% drug adherence. Quick, you guess, before reading further!
The answer is below.*
We also discussed how technology might be used to enhance adherence. I mentioned advanced design pillboxes, human or computer-aided calls to patients, and texting on cell phones. You would think that electronic prescribing of drugs would enable physicians to see if their patients had picked up their orders, but the full capability of e-prescribing is not generally in use. Most pharmacies do not fill in that portion of the electronic record, and there is no way for an individual clinician to request a fill status for a specific patient or drug order.
The setting for this discussion was a Life Sciences Insight Summit for IT professionals. The audience was engaged and offered many cogent observations.
*Answer. Tuberculosis. Why? The drug is administered in person on schedule by a public health nurse, who stays with the patient long enough to ensure that the pill is taken, that it is swallowed, and that it is not vomited up.