One of the biggest pain points in pharmacy (across the industry) is patient adherence, or a lack thereof. Nonadherence rates often seem off the charts. However, the true nature of medication adherence and non-adherence depends on the precision of measurement and reporting.
We’re here to point out some of the myths of medication adherence rates we see nearly every day, and show you how researchers have debunked them.
The long and short of it is: adherence is a numbers game. The math isn’t so hard. It’s knowing what to measure. But if you know what to measure, and how to break those measurements down to reflect the true nature of medication adherence, you, too can rank among pharmacies’ great debunkers… and better performers. And, you’ll increase the likelihood of getting reimbursed for your hard work at keeping patients on therapy, as directed.
Myth 1: The average rate of medication adherence is only 50 percent
Even in 2018, this 50 percent average seems to remain as a gold standard for adherence setback references. However, many of these reports are cited back to a 2003 World Health Organization (WHO) report (from 15 years ago), say U.S. researchers. Even more confounding (for statistics fans): nobody is completely certain where this data came from. The original WHO report cites a study dating back to 1975.
Busting the myth: The WHO report was no doubt formative to industry benchmarks. However, when taking a closer look, the “50 percent” claims are difficult to support through the study data. According to researchers, the study findings are too broad to draw that conclusion.
Further, a later meta-analysis of adherence studies found average adherence to be closer to 79 percent.
Researchers suggest, when reporting adherence rates, to:
- Specify patient behaviors related to adherence claims and the adherence component (medication initiation, implementation, and persistence), as well as the actual disease state and medication class –– whether using reporting software or doing it on your own
- Only pool data that reflects the same behaviors, such as drug fills instead of skipped doses and, drilling down, correct medication ingestion and actual refills
The key is to measure behaviors in similar patient populations. This results in more accurate and actionable data.
Myth 2: The adequate adherence threshold is 80 percent
Adherence is either adequate or inadequate. But what is adequate?
Like the 50 percent myth, there is an “adequate adherence” myth that keeps rearing its head in pharmacy reporting. Again, say researchers, nobody is certain where or how this measure came to be.
Busting the myth: It is likely that, to determine true adequate adherence, different adherence levels may be required for different medication classes to have therapeutic effects (a supply of 80 percent of days versus distribution access to 80 percent of patients).
Researchers believe 80 percent to be an arbitrary number that excludes many adherence-related behaviors. Therefore, it is not accepted as an accurate adherence “cut-off point.”
Yet, the 80 percent largely remains today a reimbursement benchmark.
Researchers suggest that pharmacies:
- “Assess and report relationships between outcomes and varying adherence thresholds;
- Base policies on evidence‐based thresholds, rather than arbitrary cutoffs, such as 80% of days covered”
Myth 3: Adherence rates don’t change
Pharmacists and researchers tend to agree: adherence is dynamic and changes continually. Yet, many studies, including those tied to reimbursement rates, measure adherence only once or only over short time periods. For example, Medicare Advantage STAR ratings rate health plans based on the proportion of members that refilled at least 80 percent of their prescribed medications over the prior year.
Busting the myth: Researchers believe that this practice “obscures the fact that a rate of 80 percent of pills taken over one year can be achieved in many ways,” including when patients are taking and not taking medications, and when they are catching up on missed doses. These adherence short-cuts and the benchmark measurements can result in outcomes that require “different interventions to improve adherence [rates].”
To avoid these adherence cut-off pitfalls (and consequences), pharmacists should:
- Take new assessments
- Include all collected data points
- Make sure software (or your own calculation method) uses advanced statistical modeling techniques versus summary descriptions
- “Assess associations between time‐dependent measures and outcomes (which are also often time-dependent)”
Myth 4: Self-reported adherence measures are not useful
A common misperception exists that self-reported adherence measures are “invalid” according to preferences and measurement biases. While there is some truth to overreporting positive adherence versus electronic and refill reports, the data should not be discounted entirely. These reports do have use — and they are likely available to you.
Busting the myth: Self-reporting can help you pinpoint reasons for nonadherence and the extent of nonadherence based on patient behaviors, such as missed doses, extra doses, misinterpreting or not following instructions, and more.
Researchers suggest using self-reporting mechanisms that:
- Identify specific adherence timeframes
- Specify measured behaviors
- Include multiple measures within those timeframes
- “Use an introduction that normalizes non-adherence,” making it feel less threatening and more candid in discussions
- Compare “self‐reported measures to objective measures assessing the same specific adherence behavior”
Which strategies and tactics has your pharmacy used to debunk adherence myths? Have you found one approach or strategy more helpful than another? Which effort had the most impact? How has your pharmacy benefited –– or not –– from initiatives you’ve implemented?
We’d love to know and may even share those experiences in future blog posts, white papers, and e-books. To share your story, please contact Jessica Gardner.
And, of course, be sure to subscribe to our blog for more tips, insights, and bulletins that can help grow your pharmacy and save you money –– all from your partners at AlliantRx.