Research to investigate and improve patient adherence to prescription drug therapies

CVS Caremark (NYSE: CVS) is sponsoring research to investigate patient adherence to prescription drug therapies and identify ways to increase adherence. Working with researchers from Harvard and Brigham and Women's Hospital, the company expects knowledge gained from the research will help health professionals better understand patient behavior and lead to developing programs that health care providers and pharmacies can use to improve medication adherence and ultimately help improve patient care and medical outcomes by avoiding costly hospital treatment.

Non-adherence to essential chronic medications has been widely recognized as a major public health problem, according to prior research cited in numerous medical journals. One quarter of original prescriptions for essential medications are never filled, and patients with important chronic diseases such as diabetes and coronary artery disease adhere to their medication only about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at over $200 billion annually. A better understanding of the predictors of non-adherence and strategies to improve medication use has the potential to meaningfully impact the public health.

"As the nation looks for ways to reduce health care spending, we need to improve patient compliance with prescribed drug therapies," said Troyen A. Brennan, M.D., Executive Vice President and Chief Medical Officer, CVS Caremark. "Many reasons have been discussed for patient non-adherence, including cost, forgetfulness, confusion when taking multiple medications, and problems with renewing a prescription. This research, which will be available not only to CVS affiliates but to all pharmacies, will help doctors, pharmacies, hospitals and health plans design programs to help patients stay on their prescribed medication treatments."

Dr. Brennan says non-compliance with a prescribed drug reduces or eliminates the positive effects of a medication. Patients who fail to take prescriptions properly can face unnecessary and costly treatments, such as hospital admissions, re-admissions, and surgeries. Patients are considered to be non-compliant if they do not fill a new prescription or do not refill an existing one, take appropriate medication incorrectly (e.g., on the wrong schedule) or take the wrong medication dose (e.g., dose is too low).

To address this significant public health problem, CVS Caremark, through a research agreement, is working with faculty from Brigham and Women's Hospital, Harvard Medical School and Harvard Faculty of Arts and Sciences to develop an interdisciplinary initiative to improve medication use. The interdisciplinary approach allows experts in disciplines like psychology, sociology and political studies to bring their expertise about patient behavior and health care policy to bear on a complex public health problem.

This research collaboration has four key components:

• Determine causes and scope of abandoned prescriptions -- Researchers know little about how often and why prescriptions are filled but not picked up at the pharmacy. A better understanding of the types of essential medication abandoned and the predictors of abandonment can be used to create better approaches to medication delivery. Specifically, the team will study the effect of different insurance structures to help design plans to support medication adherence. The study also seeks to determine the impact of the current economic downturn on insurance coverage and prescription abandonment to provide guidance on how best to support patient health in such economic conditions.
• Drive adherence through simplification and consolidation -- In a fragmented health care system, there are numerous sources of complexity that may interfere with medication adherence. Patients see multiple physicians, are charged multiple copayments for different medications, may use multiple pharmacies and may have to make many trips to the pharmacy to manage their medications. The research team will seek to assess how actions such as simplifying drug regimens and consolidating pharmacy management services within a "pharmacy home" can improve adherence. This research will provide the basic knowledge needed to help pharmacies, insurers and doctors simplify medication use and encourage adherence.
• Evaluate the clinical and financial value of adherence incentives -- Scientific literature has discussed the notion that rewarding desired behavior is a powerful tool to stimulate that behavior. The team is developing a randomized controlled trial of the effects of providing rewards for optimal medication adherence with the goal of better engaging patients in their medical care in order to improve their health. The results can provide a rigorous evaluation of the clinical and financial value of implementing novel insurance designs on patient behavior.
• Determine how electronic prescribing impacts costs, compliance and safety -- Many health care experts are looking to improved health information technology to reduce health care costs and improve safety. The researchers will examine the role that ePrescribing can play in adherence in helping companies better understand and evaluate how electronic prescriptions and processing impact medication costs, adherence and safety. This is especially important as Medicare has launched an initiative to drive electronic prescriptions.

"This research will help us understand the reasons why patients do not take their medications as prescribed. We will use this information to develop effective, evidence-based approaches to improve prescription adherence," said William Shrank, M.D., MSHS of Brigham and Women's Hospital and Assistant Professor of Medicine at Harvard Medical School, and principal investigator of the program. "We'll strive to better understand barriers to adherence that range from patient characteristics (e.g. income or marital status); patients' attitudes about their condition and the importance of medicine; understanding how to take medications appropriately; the impact of complex therapy; and, the trust and communication between the patient, the physician and the pharmacist. We hope this research will help us create strategies to promote wellness in our patients. "